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Private insurers who participate in Medicare Advantage have received guidelines from the Centers for Medicare and Medicaid Services that they must meet if they want to bid on Medicare insurance business this year. The guidelines protect sicker beneficiaries from discriminatory out-of-pocket charges for the health care services they need. …. Employers remain confident that employer-based … Read more

PokemonGo Really Is a 20-16 Augmented-reality Mobile-game developed and Released with Niantic in Cooperation Using Nintendo along with The Pokémon Company to Get I-OS along with Android Apparatus. It uses cellular phones with GPS to discover, catch, train, and combat virtual monsters, called Pokémon, that looks as though they come in the gamer’s real time … Read more

There are many reasons to develop health plan report cards. Just don’t expect most beneficiaries to make use of them. Over the past few years, considerable effort has been devoted to developing health plan report cards. Policy makers believe that if consumers are given detailed information about the quality of health care plans available to … Read more

Name Last modified Size Description Parent Directory 28-Aug-2000 11:10 – ../../../../archiveMC/9711/QNA.1.GIF 17-May-2000 12:21 1k 9711.compmon.shtml 17-May-2000 12:19 1k 9711.outlook.shtml 17-May-2000 12:20 1k 9711.editorsmemo.shtml 17-May-2000 12:19 2k 9711.contents.shtml 17-May-2000 12:19 4k 9711.news.shtml 17-May-2000 12:20 7k 9711.legal.shtml 17-May-2000 12:20 7k 9711.washington.shtml 17-May-2000 12:21 8k 9711.employer.shtml 17-May-2000 12:19 8k 9711.ethics.shtml 17-May-2000 12:20 8k 9711.states.shtml 17-May-2000 12:21 8k ../../../../archiveMC/9711/9711.compmon.ext.gif … Read more

Train an in-house team to help make the transition smooth by determining who is affected, and how ICD-10 is coming, and some health plans are already planning how they will implement the system, training staff members, working with programmers, and looking at every aspect of their operation to make sure that they will be in … Read more

When a pharmacist — for personal beliefs — refuses to fill a prescription, the health plan should be very concerned. The reason we evolved with two ears is because we survive better if we can hear two sides of an argument. This talent comes in handy in analyzing the ruckus over pharmacists refusing to provide … Read more

Crucial measures to boost competition on the sector for pharmaceutical medication and also ease entrance of viable alternatives. The agency released a listing of off-patent, off-exclusivity branded medication without any approved generics, also implemented, for your very first time, a brand new policy to simplify the review of generic drug applications where rivalry is constrained. … Read more

Virus may be evolving, experts say   Zika investigators now believe that microcephaly in newborns and Guillain–Barré syndrome in adults may be just the most obvious disorders caused by the mosquito-borne virus, according to a report from Reuters. Fueling that suspicion are recent discoveries of serious brain and spinal cord infections, including encephalitis, meningitis, and … Read more

John A. Marcille Making subtle distinctions is a talent not usually associated with mobs. That doesn’t mean that the “people,” so celebrated by poets and demagogues, aren’t often right. In this country, we like to think that they’re more often right than not. Carl Sandburg said in his poem, I Am the People, the Mob: … Read more

There’s still a way to go in reducing elective deliveries, and different insurance systems feel far different effects The successful 10-year effort led by the March of Dimes to lower the preterm birthrate is also a triumph for insurers in the thick of this societal change. For integrated health plans, though, it could be a … Read more

Health Reform and the Use of Financial Incentives in Wellness Programs The Affordable Care Act codified the worksite wellness exemption to the federal medical underwriting provisions in the group health plan market. This means companies are allowed to use an “outcomes-based” incentive model that provides financial rewards for those who satisfy a prescribed health standard … Read more

Analysis of data from claims is uncovering opportunities to advise prescribers and, through them, to improve outcomes Thomas Reinke Tweet Widget(link is external) Health plans and PBMs are taking new steps to capitalize on medication therapy’s value. Evidence is mounting that many classes of medications can reduce the cost and utilization of downstream medical services, … Read more

Medicare beneficiaries in health plans with a three-tiered drug benefit had lower drug expenses and filled fewer prescriptions than people in plans with no tiers after controlling for demographic factors, health status, and medical copayments according to a study published in Health Services Research. On average, beneficiaries in employer-?sponsored retiree health plans incurred $313 less … Read more

Brand-name manufacturers and many neurologists see danger in generic substitution, but the FDA insists that the practice is safe In the war between brand-name drug companies and generics manufacturers, each side is almost religious in its orthodoxy and intransigence. The ground they fight over is the patient. On one side are the large pharmaceutical companies, … Read more

72015 was a good year for those looking for hopeful answers to quality questions and who want the momentum to carry into next year. Consumer Reports teamed up with the University of California–San Francisco (UCSF) and the California Department of Insurance to create California Healthcare Compare, a quality and price transparency tool. Consumers’ Checkbook unveiled … Read more

Patient satisfaction remains an important characteristic of a health plan, particularly at open enrollment time. WilsonRx’s annual survey tells the tale.   …Tricare. Tricare, the health plan run by the U.S. Department of Defense, is the best health care insurer in the nation, followed closely by Kaiser Permanente, CareFirst Blue Cross Blue Shield, AARP, and … Read more

Current asthma Instructions Unite Follow-up, Treatment, and Clinical usage of biomarkers, such as fractional exhaled nitric oxide, together side normal management may offer clinicians with increased capacity to comprehend airway inflammation, streamline drug treatment, also potentially increase asthma control. Our purpose is to analyze the effect of FeNO tracking about the cost effectiveness of asthma … Read more

Endocrinologists say early treatment is essential, but health plans as a group are not yet on the same page In November, the Centers for Disease Control and Prevention reported an alarming statistic: Laboratory and claims data collected from health plans and state and federal databases such as Medicare showed that at least 1 in 4 … Read more

By John A. Marcille Sometimes breaking old ground can be just as satisfying as breaking new. Take our cover story. The article looks at how the corporate cultures at Aetna U.S. Healthcare and Kaiser Permanente shaped their reactions to recent financial setbacks and positioned them for the future. What these two plans are looking at, experts believe, … Read more

If congressional Republicans Achieve death a Sweeping medical care bill, highrisk medical spas can make a come back. Highrisk pools are all government-run health programs Offering protection To folks who’ve high priced health conditions such as HIV, cancer or kidney disorder and also can not obtain insurance elsewhere. Washington established its high heeled pool, also … Read more

Martin Sipkoff A new study finds that multiple sclerosis (MS) patients enrolled in a seven-month disease therapy management (DTM) program demonstrate increased adherence to injected medications and stay with their treatment regimens more readily than MS patients who do not participate in therapy management. The study, published in the February 2010 issue of the American … Read more

Standardization, a central database, and quick reporting are thought to improve safety Thomas Reinke A recent survey of 28 organizations reveals widespread concern about many aspects of the REMS (risk evaluation and mitigation strategies) program, which is the FDA’s primary tool for proactively addressing specific safety concerns about new and existing medications. (See “Scope of … Read more

Name Last modified Size Description Parent Directory 11-Jan-2005 13:10 – ../../../archives/0001/0001.compmon.gif 01-Jan-2000 12:00 39k ../../../archives/0001/0001.compmon.pdf 01-Jan-2000 12:00 42k ../../../archives/0001/0001.cover.jpg 01-Jan-2000 12:00 10k 0001.dmpac.chartpac…> 01-Jan-2000 12:00 12k 0001.dmpac.chartpac…> 01-Jan-2000 12:00 15k 0001.dmpac.chartpac…> 01-Jan-2000 12:00 15k 0001.dmpac.chartpac…> 01-Jan-2000 12:00 16k 0001.dmpac.chartpac…> 01-Jan-2000 12:00 8k 0001.dmpac.chartpac…> 01-Jan-2000 12:00 7k ../../../archives/0001/0001.dmpac.chartpac.pdf 01-Jan-2000 12:00 108k ../../../archives/0001/0001.news_lackcov.gif 01-Jan-2000 12:00 34k ../../../archives/0001/0001.outlook.gif … Read more

Salaries of pharmacy directors in 2003 were up substantially from 2002. Data from the 2003 Managed Care Compensation Report issued by the Hay Group, a global management consultancy specializing in human resource issues, suggest directors of pharmacy received a 14.3 percent increase in base salary from 2002 to 2003. The survey includes responses from 42 … Read more

Radiology is the name of the game in physician recruitment today, with income offers increasing by an average of nearly $50,000 over previously recorded levels, according to the national physician search company Merritt, Hawkins, & Associates. Tracking 2,043 physician recruitment assignments it conducted from April 1, 2000 to March 31, 2001, Merritt Hawkins saw average … Read more

The disease has risen quickly to become the third-leading cause of death in the world — getting there much faster than anyone expected Bob Kirsch The 2003 National Health Interview Survey found that chronic obstructive pulmonary disease would ascend from the fourth- to the third-leading cause of death in the United States by 2020. It … Read more

The California agency which governs physicians is exploring at least four doctors for devoting debateable healthcare exemptions to kids whose parents didn’t desire them . The Medical Board of California’s investigations are cooperating amid the world’s hardest measles epidemic in significantly more than the usual quarter century, as California law makers consider contentious laws to … Read more

The insurer hopes to give businesses of between 50 and 400 employees more flexibility under defined contribution Frank Diamond Officials at Horizon Blue Cross Blue Shield of New Jersey think that they might have found a niche customer base. The public health insurance exchanges opening in October will include the Small Business Health Options Program … Read more

A medical ethicist says it’s time to acknowledge that limited resources will cover limited services Voicing the idea of rationing health care services is a political deathtrap, or so ethicist Leonard Fleck, PhD, has been told. Fleck, a professor of philosophy and medical ethics at Michigan State University, served on a committee that recommended to … Read more

Americans spent 34 percent more for specialty anti-inflammatory agents used to treat rheumatoid arthritis in 2005 than any other specialty drug category. The specialty anti-inflammatory class had the highest per-member per-year (PMPY) expense of all specialty classes, according to the Specialty Drug Trend Report from Express Scripts. The class, comprising four agents — Enbrel, Humira, … Read more

In theory, this approach could help untangle some knotty cost and quality concerns about medications as they move from clinical trials and into clinical use. But there’s that credibility issue. First of two parts The idea of using real-world evidence to improve health care is really something of a no-brainer. It’s just plain common sense. … Read more

Nearly 80 per cent of children hospitalized in the USA are awarded medication which were approved just for mature patients, a new study found. Even though the research did not start looking at safety problems, the clinic is potentially problematic, experts said. “the situation in which you are using a medication off-label is, often times, … Read more

Costs are rising as physicians order more of all kinds of tests, from low-cost routine tests to high-cost genetic assays When a friend’s child had a rare neurological disorder recently, Michael J. Misialek, MD, a pathologist at Newton-Wellesley Hospital in Massachusetts, was asked about the diagnostic value of a lab test. The cost of this … Read more

Leonard D. Schaeffer HEALTH PLAN 2009 Leonard D. Schaeffer is the chairman and CEO of WellPoint Health Networks. WellPoint and another Blues plan, Anthem, are in the process of merging. With 26 million members, the new entity, to be called WellPoint, would be the largest insurer in the nation. Health care is projected to grow … Read more

Are some managed care companies operating a little too close to the margin? A surprising 22 percent of the HMOs examined recently by the National Association of Insurance Commissioners failed a test run of the risk-based capital formula NAIC is considering as a standard for managed care organizations’ minimum capital reserves. Last June, the NAIC’s … Read more

The share of women age 18 to 64 without insurance has risen in the last five years, from 13 to 18 percent, despite the fact that 7 out of 10 of those without coverage work or have husbands who do. The Commonwealth Fund study concludes the drop is rooted in changes in employee contributions and … Read more

Health plans have much at stake as Congress moves to lay down the do’s and don’ts about use of info gathered via genetic testing. Michael Levin-Epstein Managed care governmental affairs and medical directors have been monitoring federal genetic testing legislation for several years, but now, Hill insiders say, with the unanimous passage of the Genetic … Read more

“Insignificantly intrusive medical procedure decreases torment, scarring and recuperation time after a medical procedure,” said Binita Ashar, M.D., head of the Division of Careful Gadgets in the FDA’s Middle for Gadgets and Radiological Wellbeing. “RASD innovation is a particular advancement in insignificantly intrusive medical procedure intended to upgrade the specialist’s entrance and perception inside limited … Read more

Salaries for staff pharmacists saw a healthy jump of 5.5 percent in 2005, compared to 2004. Median income for all Americans remained stable between 2002 and 2003, according to the latest figures available. The salaries of pharmacy team managers, staff pharmacists at mail order/online pharmacies, and clinical pharmacists, were collected and collated by Mercer Human … Read more

The aggregate remuneration for the most generously compensated clinic pioneers in Massachusetts rose 95% more than five years, with 12 of the heads detailing pay more than $2 million in the most as of late accessible year. In the latest year for which pay information are accessible, the 12 most elevated repaid medical clinic and … Read more

All-products provisions in health plan provider contracts are slowly being negotiated, legislated, and regulated out of existence. They are now illegal in at least four states; legislation is pending in several others. Non-negotiable all-products requirements leave physicians with an all-or-nothing choice: Either agree to be on the provider panels for all current and future products … Read more

COVER STORY Medical Directors Explain Hows and Whys of Burnout These high-achievers wrestle with competing interests as they operate both in the medical and business worlds Frank Diamond HPV Vaccine Goes Underused Only about 35 percent of girls get the full three doses of the vaccine for the human papillomavirus, which causes most cervical cancers … Read more

Repeal and Replace, Part Deux A return to the dark days of unaccountable care? One thing lost in the din about repealing the Affordable Care Act is that the ACA gave value-based health care the biggest shove forward it’s ever gotten. The health care reform law set standards for the development of quality measures and, … Read more

Steve Jobs famously staked his claim at the intersection of technology and creativity. Health insurers are looking for the intersection of technology and benefits knowledge, but are not quite sure how to get there. Do you hire information technicians and train them in the ways of health coverage, or do you hire (or promote from … Read more

consumer-directed model isn’t taking the country by storm, but its innovations are influencing other coverage designs When several start-up companies launched consumer-directed health plans more than a half-dozen years ago, terms like “incremental change” didn’t come up much. “The founders of consumer-directed health care always saw this as a transformational strategy that would improve health … Read more

Disarming That the superbugs resistant to antibiotics Would Be Your Ultimate Goal in The worldwide struggle a pandemic called to kill more people than all cancers combined within the upcoming few decades. New research has found a method to disarm the urinary-tract infecting super-bug, also referred as E. coli ST131, making it benign. Painful urinary … Read more

Ibrahim M Abbass, RPh, PhD University of Texas School of Public Health, Division of Management, Policy and Community Health, Houston, Texas Trudy M. Krause, DrPH, CPHQ University of Texas School of Public Health, Division of Management, Policy and Community Health, Houston, Texas Salim S. Virani MD, PhD Health Policy, Quality & Informatics Program, Michael E. … Read more

We’ve known Michael O’Donnell, the publisher and editor in chief of the American Journal of Health Promotion, for 30 years. He is not prone to hyperbole. So he got our attention when he recently wrote that he had just published “the most extensive and well-conceived review conducted to date” on the financial impact of workplace … Read more

Pass-through pricing is a good way for a payer to realize the benefit of increased prescribing of generic drugs Linda Cahn Many facts are widely circulated about generic drugs, including these: Today, 7 out of 10 prescriptions are filled with generic drugs. The average price of a generic drug prescription is just under one fourth … Read more

Lower Copays Sweeten Outcomes-based Deal for Brilinta The contract between UPMC Health Plan and AstraZeneca will help the brand-name antiplatelet drug compete against generic versions of Plavix by lowering the copay to $10. Modest, at best: The effect of getting rid of copays for antiplatelet drugs A study designed to test whether eliminating copays would … Read more

Clinical Brief: Safety of Lipid-Lowering Therapies Download supplement This Brief summarizes four studies that examine the safety of HMG-CoA reductase inhibitors (statins). It also includes an analysis for MCOs by Steven R. Peskin, MD, MBA. Highlights: The Report of the National Lipid Association Statin Safety Task Force International Studies on the Comparative Safety of Rosuvastatin … Read more

Regional health information organizations are getting more scrutiny on Capitol Hill. They might hold the key to funding a national online network that links providers. John Carroll RHIOs have become a hot commodity on Capitol Hill, and Sen. Hillary Rodham Clinton has become one of their most visible champions. With bipartisan harmony rarely seen in … Read more

The fact that we waste hundreds of billions a year is all the more infuriating because we have the ability right now to stop the hemorrhaging Joseph Burns Contributing Editor Call it the $750 billion question. That’s the estimate for how much the U.S. health system wastes each year, according to the Institute of Medicine. … Read more

Sur-prise medical Statements occur when a patient receives Attention at an Out-of-network centre, or by a out-of-network provider for an innetwork centre. Tackling the excessive invoices was a important health priority for Congress this past year, but has been pushed into the legislative acts way-side because Washington’s attention was held hostage by the COVID-19 pandemic … Read more

Name Last modified Size Description Parent Directory 28-Aug-2000 11:10 – ../../../../archiveMC/9711/QNA.1.GIF 17-May-2000 12:21 1k 9711.compmon.shtml 17-May-2000 12:19 1k 9711.outlook.shtml 17-May-2000 12:20 1k 9711.editorsmemo.shtml 17-May-2000 12:19 2k 9711.contents.shtml 17-May-2000 12:19 4k 9711.news.shtml 17-May-2000 12:20 7k 9711.legal.shtml 17-May-2000 12:20 7k 9711.washington.shtml 17-May-2000 12:21 8k 9711.employer.shtml 17-May-2000 12:19 8k 9711.ethics.shtml 17-May-2000 12:20 8k 9711.states.shtml 17-May-2000 12:21 8k ../../../../archiveMC/9711/9711.compmon.ext.gif … Read more

For many affected by vitreous degradation, surgery was the only treatment until the development of ocriplasmin Unless you have been involved in ophthalmology specifically, you have probably never heard of a sight-threatening condition called vitreomacular adhesion (VMA). There is limited epidemiologic data about this progressive, commonly asymptomatic disease, and the precise incidence has not been … Read more

Health plans continue to push patients towards off-label use of pain relievers and alternative treatments for symptom pain Martin Sipkoff About 10 million people suffer from fibromyalgia, a painful, persistent, and incurable disease that for too many years many physicians believed was entirely psychological. “There has always been a lot of misunderstanding about the disease, … Read more

Have insurance coverage for prostate cancer screening tests. The Society admits that different opinions exist concerning whether screening for prostate cancer cancer decreases the possibility of dying from prostate cancer. Until this time if studies have been conclusive, men, in consultation with their doctors, should be free to determine in an individual basis if testing … Read more

The Genetic Information Nondiscrimination Act will have a profound effect on insurers, even if we’re not quite sure what it will be John Carroll Contributing Editor Individuals shopping for health insurance have traditionally had to deal with an underlying principle that guides their relationship with an insurer. They’re expected to be open about their health … Read more

Steven Peskin, MD Three times during the past month a friend has asked for advice regarding his/her personal health care or that of a family member out of frustration and concern stemming from not receiving clear communication/information about the health problem(s). This scenario is all too common. Read moreabout Is There an Advocate in the … Read more

Insurance coverage was never meant to handle new pharmaceutical breakthroughs on the radar — breakthroughs that can cost anywhere from $90,000 to $300,000 a year per patient, says F. Randy Vogenberg, RPh, PhD, principal of the Institute for Integrated Healthcare and a member of P&T’s Editorial Board. There will be pressure on everybody to find … Read more

Insurers say opening up clinics in drugstores will make health care more convenient, more timely—and potentially less costly. But will it also bring unwanted commercialization and fragmentation? As health insurers and drugstores join forces to create clinics within the stores’ spaces, they’re betting that their gamble to provide easily accessible medical care will pay off … Read more

Burgeoning legions of managed care detractors would love to see this practice spread, but it would take some high-maintenance gardening. It’s perhaps ironic that Minnesota, where the wind roars off Lake Superior with all the force of a full-body slam, has provided the habitat to let a “plant” like direct contracting grow. This is where, … Read more

John Marcille Change is difficult for many people. They fear it, and sometimes with good reason. The changes we observe in the organization of the physician workforce — changes that our cover story, starting on Page 14, is about — are certainly disconcerting to some physicians. Simply put, the long erosion of small practice is … Read more

Ultragenyx will present voucher to Novartis upon closing of transaction Ultragenyx Pharmaceutical, Inc., has agreed to sell its rare pediatric disease priority review voucher (PRV) to Novartis for $130 million. Ultragenyx was awarded the voucher under an FDA program intended to encourage the development of treatments for rare pediatric diseases. The company received the PRV … Read more

By Paul Wynn Associate Editor For a moment, imagine health care providers as the members of a big-city orchestra. Primary care physicians, specialists, nurses and pharmacists don formal wear and hoist instruments to entertain concertgoers. When the conductor waves his baton, is the sound harmonious? It wouldn’t be, if the orchestra followed medicine’s traditional pattern. … Read more

For physicians, reclaiming a measure of clinical autonomy can be a matter of health itself. But alas, there’s no one blueprint to follow. TAKING BACK THE POWER? Burnout can be subtle,” says John Henry Pfifferling, Ph.D. “It is a slow, aggregating erosion of energy. It’s not something that happens overnight. You no longer look forward … Read more

We know Watson, the supercomputer, for its vast fund of knowledge and thinking prowess when machine bested man, defeating the all-time Jeopardy champ for games won, Ken Jennings (74), and Brad Rutter, Jeopardy’s highest money winner ($3,470,102), and winning against Jennings in a head-to-head Tournament of Champions. Now, Watson is flexing her considerable problem-solving muscle … Read more

Each year the National Committee for Quality Assurance releases its huge report on what’s going on in the health care industry: The State of Health Care Quality. It’s professionally presented and packaged, and always chock full of the sort of information that can keep those who toil in managed care, as well as those who … Read more

Critics say insurers fail to make a distinction between those who commit fraud and those who simply make mistakes John Carroll Bryan Liang was getting ready for his close-up when he took a moment to talk to Managed Care last month. CBS News had carefully picked a California beach as the setting for a planned … Read more

Until GE found a better way to produce and deliver I123, most nuclear medicine labs had to make do with an isotype that produced an inferior image This edition of Tomorrow’s Medicine highlights neuroblastomas and pheochromocytomas — two different tumors that affect widely differing age groups but share several characteristics. Neuroblastoma Most people do not … Read more

NCQA decided not to hold managed care companies that do not carve out behavioral health benefits to the same accreditation standards that managed behavioral health organizations face — at least, for now. NCQA’s managed behavioral health organization accreditation program began last year. Next year, NCQA would have extended those standards to plans that administer mental … Read more

On the previous 2 decades the majority of the efforts in HIV vaccine development are predicated upon the usage of their HIV Env with the wish to induce immunity. Even though the aim of a preventative immunity remains important, secondary end points are increasingly being contemplated at the current as more viable end points in … Read more

Head Off All the Risks in an Acquisition Tom Ewers and Munzoor Shaikh of West Monroe Partners discuss the ins and outs of pre-close integration planning for health care payer mergers and acquisitions. The M&A process should begin by clearly defining both the acquisition strategy, type of acquisition (Leverage Business Model (LBM) or Re-invent Business … Read more

Hospitals are hyping better outcomes with the robot, but economics and marketing may be driving the push With three hospitals and 311 beds in small cities in south central Ohio, Adena Health System is not exactly a major metropolitan medical center. But its website does herald Adena Health as the only provider in its region … Read more

Blue Cross Blue Shield of Massachusetts believes its newly inked provider pact with Caritas Christi Health Care — a community-based hospital network in New England with a network of 1,100 physicians that cares for about 60,000 members — will help bury the industry’s fee-for-service payment model. In a nutshell, the payment plan — dubbed an … Read more

A brand fresh study that appeared at over two million Emergency department visits discovered more than just 1 in 5 patients that travelled along to ERs of their healthinsurance networks was medicated with an”out-of-network” physician — and therefore subjected to additional charges not included in their own insurance program. However, the invoices can be higher … Read more

Together with Declining levels of estrogen in postmenopausal women, bone intake is significantly more than formation, that induces a bone negative balance. Ergo, these women are especially prone to osteoporosis. In China, post menopausal osteoporosis is getting to be a critical public health issue as a result of the rapid gain in the normal expected … Read more

Medicare+Choice Reform: Hope, but No Quick Action Expected There have been small accomplishments, and wheels have been churning for more forceful action — that is, they were until Sept. 11. Michael Levin-Epstein Indirect Costs: Asking plans to keep employees on the job Employers in revolt against fast-rising premiums could ask HMOs to pay more attention … Read more

Back in the heyday of managed care, primary care physicians were poised to occupy the central role in health care delivery. Over the last half-decade, that has changed. A survey by Merritt, Hawkins, & Associates, a search-and-consulting company, suggests that physicians consider themselves to be busy but poorly paid, although maybe everyone who collects a … Read more

Back in 2006 with the passage of the Tax Relief and Health Care Act, Centers for Medicare & Medicaid Services (CMS) was charged with establishing a physician quality reporting system that would include incentive payments to eligible providers. This Physician Quality Reporting Initiative (PQRI) initially targeted individual providers, but in 2010, group practices may also … Read more

Purpose: To evaluate the cost-effectiveness of telemedicine services in patients diagnosed with preterm labor (PTL). Design: Women hospitalized with a diagnosis of PTL during a 3-year study period were identified within a health maintenance organization. Inclusion criteria: singleton gestation, stabilized after tocolysis and discharged from the hospital, and participation in the HMO’s preterm- birth prevention … Read more

2007 January Cover Story Erosion of Employer-Sponsored Health Care: Bad for Everyone Will ‘Mea Culpa’ Work for Health Plans Too? Employers Publish Guide on Prevention’s Worth Rise of the PHR Peer-Reviewed The Use of Therapeutic Interchange For Biologic Therapies Full contents for January 2007 February Cover Story Health Plans Can Learn From VHA Turnaround As … Read more

For now, consumers are willing to pay extra for direct access. How long that continues is linked to whether old practice habits can be broken. The specialist is certainly becoming more special these days, perhaps soon to be included with the spotted owl and plains buffalo as one of our endangered species. A recent Forbes … Read more

Medical group practices that are owned by hospitals or integrated delivery systems (IDS), or are just affiliated with them, are no more immune to cost increases and pressure on payment rates than are their physician-owned practice counterparts. New data indicate that total operating costs per full-time equivalent (FTE) physician in IDS medical group practices increased … Read more

Resources Disease Management Forum Call for Manuscripts Subscribe Rate Card Production Details for Ads and Inserts Classifieds Recent blog posts Disruptive Innovation Could Up-End an Innovative Industry Is There an Advocate in the House? Health Reform and the Use of Financial Incentives in Wellness Programs An Easy and Profitable Way to Turbocharge Disease Management? Welcome … Read more

Reinventing Hospice Medicare considers going beyond palliative care, and Aetna finds that allowing curative treatment and loosening admission criteria reduce costs and improve quality of life Susan Worley Patient Liquidity at Time of Service Big New Problem for Providers, Insurers Insured patients are liable for ever greater out-of-pocket payments, and providers will have to evaluate … Read more

About 99 percent of workers in plans sponsored by employers have a prescription benefit. And while the majority don’t have to pay a separate prescription deductible or have an annual out-of-pocket limit that applies only to prescription drugs, about 13 percent do, according to the 2012 Kaiser/Health Research & Educational Trust (HRET) Employer Health Benefits … Read more

U.S. Hospitals Take “Better Safe Than Sorry” Approach to Zika Virus European Union launches medical corps   Health care providers in the U.S. are adopting a “better safe than sorry” approach to the current Zika virus outbreak, according to an article posted on the FierceHealthcare website. At the Cleveland Clinic in Ohio, for example, health care providers … Read more

Deal with people’s isolation and disconnection to head off physical health problems—and possibly health care costs. First, a story—because Robin Caruso, the chief togetherness officer at CareMore, loves telling stories. There once was a man who heard voices. He heard voices because of the bipolar disorder that had plagued him for years. As part of … Read more

As new specialty pharmacy care becomes more dominant, companies devoted to managing these products and their associated costs are finding a market. Thomas Morrow, MD Few readers of this column could possibly miss the daily headlines concerning the continuing crisis of health care costs. One of the most rapidly rising sectors of care is the … Read more

Less expensive corticosteroids could treat the same problems Medicare spent more than $1 billion over a five-year period on a high-priced drug that has not been proven more effective for a collection of inflammatory conditions than much less expensive corticosteroids, research by the Oregon Health & Science University/Oregon State University College of Pharmacy shows. The … Read more

What Health Plans Should Know About the Medicaid Challenge Forty-nine states now offer managed care plans to beneficiaries of the 30-year-old federal-state Medicaid program, and statehouses look hopefully to managed care as a way to harness fast-growing Medicaid costs. The Medicaid market offers opportunity for managed care plans, but it poses special challenges, too. Here’s … Read more

Hospitals have made astonishingly little progress, but CMS is forcing the issue Patient safety is emerging as a top priority among health plans. In a study published in the April Health Affairs, researchers found that the adverse event detection methods commonly used to track patient safety in the United States today miss 90 percent of … Read more

A peptide fusion protein can stem the tide of abnormal, excessive bleeding Thomas Morrow, MD Platelets are amazing components of our bloodstream. Not actually cells (they lack a nucleus and major metabolic machinery) and available in large quantities, they respond in a moment’s notice to a leak in our blood vessels to prevent catastrophic bleeding. … Read more

“Medicare secretary Seema Verma declared on Tuesday night which Hospitals may harness 30 billion in’no strings attached’ coronavirus grants — a movement that got her plaudits from healthcare providers but also the one her rival, Health and Human Services Secretary Alex Azar,’d intended to make, even based on three people near the circumstance. Azar, nevertheless, … Read more

There is no such thing as an unqualified success in this life, and even our cover story, which examines the amazing turnaround at the Veterans Health Administration, concedes that this government system is not perfect. The problems that it has, however, remind me of the stories at the turn of this decade fretting over what to … Read more

Health plans and other providers of disease management services might do better to emphasize the pursuit of better outcomes, rather than guaranteed savings, a new study implies. “Return on Investment in Disease Management: A Review” says that there is just not enough data to determine whether DM saves money. The study reviews literature on DM’s … Read more

Once a sleepy system of indemnity insurers, the Blue Cross and Blue Shield network has awakened with the fervor of competition as its 63 plans strike deals with one another to gain muscle in the health care market.During May, three mergers made headlines. On May 3, Blue Cross of Northeastern Pennsylvania and Capital Blue Cross … Read more

The historically strong relationship between Rocky Mountain Health Plans and its doctors helps contain costs Frank Diamond That one had to hurt. The June 1 issue of the New Yorker magazine contained an article called the “The Cost Conundrum: What a Texas Town Can Teach Us About Health Care.” Written by Atul Gawande, MD, a … Read more

Costs are relatively low for this minimally invasive procedure, compared with open surgical interventions for vertebral compression fractures, such as internal fixation and spinal fusion. Susan A. Levine, D.V.M., Ph.D. Hayes Inc. Lawrence A. Perin, M.D., M.B.A. Chief of Medical Staff, Aviano Air Force Base, Italy Diane Hayes, Ph.D. Hayes Inc. and School of Medicine … Read more

Economic uncertainty, job loss, and declining insurance coverage all led to a marked slowdown in prescription utilization in 2008, but that downturn is reversing as the economy slowly picks up. According to the CVS Caremark report Insights 2010: Evolving Pharmacy Care, there was a slow rise in prescription utilization in 2009 as consumer confidence returned … Read more

More and more, PPOs are coming under scrutiny, according to InterStudy Publications, which found that 40 states have passed some level of PPO regulation. That’s a big increase since 1992, when only a dozen states had regulations specific to PPOs…. Cost remains the major factor that small employers weigh when deciding whether to offer benefits, … Read more

Overall drug costs are likely to increase over the next couple of decades because of the size of the aging baby boom generation in relation to the total population. That statistic is even more sobering when you realize that the proportion of Americans diagnosed with Alzheimer’s disease is projected to nearly triple. In fact, the … Read more

Fewer children are falling through society’s safety net, recent government statistics show, but that might change as states face the daunting challenge of trying to insure more youngsters with less money. A report from the Centers for Disease Control and Prevention shows that the percent of children without health insurance declined from 13.9 percent in … Read more

Most types of prostate cancer progress slowly and, increasingly, men with very moderate or moderate forms of the disease make the same choice as the author. When my urologist told me my prostate biopsy came back positive, I wasn’t surprised. My father had prostate cancer, and my two older brothers had prostatectomies when they were … Read more

MANAGED CARE November 1999. ©1999 MediMedia USA Not surprisingly, the House of Representatives’ 275–161 vote affirming the Norwood-Dingell health care reform bill prompted wailing and gnashing of teeth from the insurance industry. A Health Insurance Association of America study tallied 408 new mandates in the bill — more than double that proposed in Norwood’s 1998 legislation, PARCA. … Read more

Software Weds Big Data, the CT Angiogram To Avoid Invasive Procedure HeartFlow says its algorithm can reduce the need for invasive angiograms by crunching data collected by noninvasive CT angiograms. A number of years ago, a friend, also a physician, experienced chest pain. His symptoms were serious enough that a reputable cardiologist at a nationally … Read more

Details may vary according to the characteristics of the providers, but there is a general framework Commercial payers can be a little reluctant to get into a lot of details about their accountable care organization (ACO) contracts, not wanting competitors to know too much. It’s also true that contracts vary according to the size, experience, … Read more

Name Last modified Size Description Parent Directory 11-Jan-2005 13:10 – 0002.washington.html 20-Jun-2003 16:09 8k 0002.uk.html 20-Jun-2003 16:09 17k 0002.qna_bodenheimer..> 20-Jun-2003 16:09 24k ../../../archives/0002/0002.outlook.pdf 01-Feb-2000 12:00 29k 0002.outlook.html 20-Jun-2003 16:09 2k ../../../archives/0002/0002.outlook.gif 01-Feb-2000 12:00 47k 0002.news_warning.html 20-Jun-2003 16:09 2k 0002.news_tenncare.html 20-Jun-2003 16:09 2k 0002.news_premiuminc..> 09-Apr-2003 23:27 1k 0002.news_premiuminc..> 01-Feb-2000 12:00 19k 0002.news_pharmacyco..> 01-Feb-2000 12:00 61k 0002.news_pharmacyco..> … Read more

When I asked Senior Editor Frank Diamond to do this month’s cover story on risk adjustment, I was intrigued by the concept. Measure the sickness of populations — even individual patients — so that payers, plans and providers can set rates more scientifically. I knew there was considerable dispute about how advanced this “science” was, … Read more

If clinical mistakes were as common as clerical ones, nobody would leave a hospital alive. Something needs to be done, and done soon. Michael S. Victoroff, MD The U.S. medical claims payment system was designed by Kafka and implemented by Monty Python. Its inefficiency and high error rate are exacerbated by a disappointing volume of … Read more

Pilot vaccination program will be executed in three African countries The world’s first malaria vaccine will be rolled out in pilot projects in sub-Saharan Africa, the World Health Organization (WHO) has announced. Funding is now secured for the initial phase of the program, and vaccinations are due to begin in 2018. The vaccine, known as … Read more

Last May, two health advocacy groups filed a complaint with the Office for Civil Rights at HHS accusing four insurers selling plans in Florida of discriminating against people with HIV/AIDS by putting the drugs for treating the condition on the top tier of their formularies. Researchers at the Harvard School of Public Health have followed … Read more

Has the price of increased life expectancy been greater rates of people living with disability? A study published in the Proceedings of the National Academy of Sciences challenges this popular assumption. The share of older people with chronic disabilities fell from 26 percent in 1982 to 20 percent in 1999. The improvement is due to … Read more

With 11th-hour negotiations over the fate of Tennessee’s once ambitious health program for the working poor and Medicaid population — TennCare — running right up to Managed Care’s deadline, it was impossible to tell just what might emerge from the talks. Gov. Phil Bredesen and patient advocates have been wrangling over either rationing care for … Read more

New treatment approaches offer hope   Approximately two million Americans are hooked on prescription opioids or heroin, and an overdose of pain pills kills 91 people every day. Approximately 20 years ago, pharma companies invested heavily in alternative treatments and “failed miserably,” Dr. Nora Volkow, director of the National Institute on Drug Abuse, told Medical Xpress. Now, … Read more

Devices that selectively destroy the renal nerves that affect hypertension have gained international approval, and availability in the United States is not far off For more than three decades the National Heart, Lung, and Blood Institute has guided medical care for high blood pressure and raised awareness of the need for proper control. We know … Read more

High, together with common co-authorships on major brand new papers inside the Lancet and The New England Journal of Medicine along with also an influential pre print. According to which seemed like a massive patient statistics trove from physicians across the Earth, the newspapers delivered apparently authoritative news about if approved medication were safe to … Read more

Highmark’s effort to get physicians up to speed with 21st century technology has been extended with a bonus system based on federal standards John Carroll When Don Fischer, MD, contemplates the future of health care, he sees an electronic health record in the hands of almost every physician in the country. And Fischer, the chief … Read more

The Bay State can boast of the lowest uninsured rate, but the high costs give even proponents pause.   These details will seem familiar: an individual and employer mandate, guaranteed issue, community rating, a health insurance marketplace, and government subsidies for those who can’t afford coverage. They were the ingredients of Massachusetts health care reform … Read more

Recommendations for ovarian, breast, and pancreatic cancer. The NCCN Clinical Practice Guidelines in Oncology or Genetic/Familial highrisk Assessment: Breast, Ovarian, and Pancreatic, Version 1.2020 comprises several upgrades –including brand new and expanded sections on hazard assessment and direction linked to three big cancer types–while keeping an even more conservative way toward analyzing clinics where in … Read more

While researchers see flaws in the MA program, the federal government seems content to pay insurers billions of dollars in bonuses each year—at least for now. Health plans see MA as as a pretty attractive market for the most part, says Gretchen Jacobson of the Kaiser Family Foundation. Health insurers are never going to win … Read more

“Look before you leap” might be the saddest phrase one can hear in free-fall, but it seems to be the advice given by the Agency for Healthcare Research and Quality regarding the patient-centered medical home. “Primary care clinicians, health care systems, insurers, state governments, families, and communities” see PCMHs as a solution to many of … Read more

Surveys say a lot about quality and are continuously conducted by HMOs and accrediting bodies. The authors suggest medical groups follow suit. Surveys say a lot about quality and are continuously conducted by HMOs and accrediting bodies. The authors suggest medical groups follow suit. “Why measure satisfaction when the health plans we contract with already … Read more

When the Medicare Part D program began in 2006, it increased drug coverage for Medicare beneficiaries from 59 percent to 89 percent, says Christopher C. Afendulis, PhD, a lecturer in the department of health care policy at Harvard Medical School. Afendulis and colleagues sought to determine whether this change reduced hospitalization rates for conditions sensitive … Read more

“I am definitely excited about where primary care is going,” says the founding dean of the Jefferson School of Population Health, and the Dr. Raymond C. and Doris N. Grandon Professor of Health Policy at Thomas Jefferson University. Here he speaks with John Marcille, editor of Managed Care, and Sonja Sherritze, editor of P&T, about what drives … Read more

The majority City Health Works’ customers are inferior, juggling seven or even more prescriptions and confronting chronic ailments that often spiral unmanageable. Destini Belt-on is not a doctor or a nurse. She is an experienced wellness coach, also a trusted neighbor in Harlem, she moves where practices and hospitals cannot — to patients’ homes to … Read more

The impact of this debilitating disease has been largely underestimated, yet new biologic agents offer significant clinical benefit to those afflicted. David M. Pariser, MD Professor, Department of Dermatology, Eastern Virginia Medical School, Norfolk, Va. Full text available in PDF INTRODUCTION Plaque psoriasis, also referred to as psoriasis vulgaris, afflicts upwards of seven million Americans … Read more

Color charts How physician groups with capitated contracts determine capitation rate adequacy How physician groups protect themselves from outliers Paul LendnerPaul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und Fitness. Er schreibt bereits seit über 5 Jahren für das Managed Care Mag. Mit seinen Artikeln, die einen einzigartigen Expertenstatus nachweisen, liefert er unseren … Read more

Large and mid-sized employers are turning to health management programs to keep workers happy and productive. Percentage of employers that offer the following services, either directly or through their health plans… Color chart SOURCE: FAX FACTS SURVEY ON HEALTH MANAGEMENT, WILLIAM M. MERCER INC., NEW YORK, 1999 Paul LendnerPaul Lendner ist ein praktizierender Experte im … Read more

William Silverman, MD, FAAP Pediatric Medical Director, Horizon/Mercy, Trenton, N.J. William Silverman, MD, FAAP Pediatric Medical Director, Horizon/Mercy, Trenton, N.J. Also available in PDF Introduction On June 19, 1998, the Food and Drug Administration licensed palivizumab, as the first monoclonal antibody introduced into clinical practice for the prevention of an infectious disease, respiratory syncytial virus … Read more

Over the past 18 months, the managed care industry has seen significant consolidation by UnitedHealth Group, WellPoint, and Aetna — three of the largest health plans in the industry. Because of their sheer size, they have benefited from great market leverage, economies of scale, and solid internal cash flow. As a result, they are in … Read more

In a world of new access models and price-conscious consumers, the traditional route of patients making appointments to see doctors is being squeezed. These days, consumers are really only interested in schlepping to see a physician when faced with more complex needs. From the physician perspective, this creates a dilemma: While the mix of patients … Read more

A Researcher at Duke University has discovered That a potential new Type of small molecule medication that simultaneously block 2 soughtafter aims from the treatment of this pain. All these Proof of Concept experiments, also printed June 1 at Scientific Reports, may cause the growth of a new medication to treat ailments such as skin … Read more

This Employee Benefit Research Institute official sees little change in the level of health benefits so long as unemployment remains low Linkedin Share Button (link is external) Tweet Widget (link is external) Share on Facebook (link is external) Google Plus One (link is external) MANAGED CARE April 2006. ©MediMedia USA This Employee Benefit Research Institute … Read more

From the USA from 2001-2002 into 2012 2013, primarily based on research by the National Institute on Alcohol Abuse and Alcoholism,  a part of the National Institutes of Public Health. Almost 10 million Americans, or 4.1 per cent of their mature populace, used antipsychotic drugs in 2012 2013 that a category of drugs which features … Read more

By reducing restenosis, these devices will save managed care money. Technophiles would be hard pressed to come up with better names than Cypher, Cypher Stallion, Achieve, Taxus, Express and Maverick. But it is unlikely that most managed care executives would guess that these names represent an industry that, up until now, has been neglected by … Read more

Majority Leader McConnell wants to end repeal debate before July 4 recess Senate Republicans might keep some of the taxes imposed by the Patient Protection and Affordable Care Act (PPACA) for a few more years to pay for their own repeal bill, according to Politico. Many of the upper chamber’s GOP lawmakers want to make their repeal … Read more

Despite the recent news that Medicare will not exclude erectile dysfunction drugs from coverage limitations, health plans responded with a ho and a hum. That’s because when sildenafil (Viagra) arrived on the scene in 1998, health plans and employer groups got together and hashed out a benefit package that took into account the risks, benefits, … Read more

The number of Americans who believe for-profit hospitals provide better care and customer responsiveness than their not-for-profit counterparts has dropped dramatically over the past few months, to the point where quality is rated roughly the same in the two hospital types, according to a Kaiser/Harvard Health News Index survey. Whether the decline is a coincidental … Read more

What Happened to EBM? Evidence Based Medicine The drumbeat of EBM — Evidence Based Medicine — seems less vigorous in the wake of enthusiasm for new models of care — Medical Homes and Accountable Care Organizations — and reimbursement based on performance, outcomes, or episodes of care. A good definition of EBM from Sackett, et. … Read more

Many who claim to be constructing such entities are really creating ‘clinically integrated organizations’ Organizations that are not aligned with the definition of an ACO can be more accurately described as clinically integrated organizations (CIOs). The major difference between the two is that true ACOs, by definition, are Medicare fee-for-service (FFS) entities only. HMOs compared … Read more

HMOs, medical associations, and pharmaceutical companies should all expect more scrutiny regarding how they play the political game. John Carroll As sweepstakes go, the grand prize didn’t have a lot of glitz. There was a trip for four to the nation’s capital, with coach air fare, standard hotel accommodations, a four-hour bus tour, and $300 … Read more

Resources Contact Us Disease Management Forum Call for Manuscripts Subscribe Rate Card Production Specifications for Ads and Inserts Classifieds Site Map Navigation Popular content Recent blog posts Occupy the OR A Historical Perspective on Where We Are Reports of the Death of Disease Management Are Greatly Exaggerated The Death of Disease Management (Finally) Would Steve … Read more

Drug-related adverse outcomes were noted in nearly 1.9 million inpatient hospital stays — 4.7 percent of all stays — and 838,000 treat-and-release emergency department visits (0.8 percent of all visits), according to the report “Medication-Related Adverse Outcomes in U.S. Hospitals and Emergency Departments, 2008” from the Agency for Healthcare Resources and Quality (AHRQ). In the … Read more

NCQA hopes its revamped accreditation process and documents modeled on Consumer Reports will mean more use by employers and the public. Most folks who have shopped for a car have seen, at one time or another, Consumer Reports’ simple visual method of rating various aspects of vehicles. I first saw the magazine’s familiar bubbles in … Read more

A Minnesota medical group that contracted with HealthPartners, a not-for-profit HMO, was able to improve cost of care, physician compensation, and patient access without harming patient satisfaction when the group converted from a salary payment system for physicians to one solely dependent on physician productivity. Before 1998, physicians were paid a salary, with all their … Read more

“The central test for any new technology,” says this medical informaticist, “is whether you can get home earlier to do things you’d rather be doing.” Working as a teenager in a small-town drug store, Mark Frisse saw firsthand the difference that health care providers can make in people’s lives and found himself drawn to the … Read more

The proliferation of clinical practice guidelines gives health plans plenty of models for developing their own. Which guidelines are better than others can depend on their creators’ methods and motives. Blue Cross Blue Shield of Massachusetts had a problem. Clinical awareness of sleep apnea was coming of age. Its physicians wanted to know what to … Read more

How do you devise a capitation plan that works? With understanding, hard work and gumption, says the chief financial officer of Sharp Rees-Stealy Medical Group in San Diego. Developing a successful compensation system for physicians in a medical group means creating a method that can evolve with the group practice. Of the different schemes around … Read more

COVER STORY Missing the Mark Health plans that miss the mark are out there, but trying to identify them is akin to the plight of the X-Files agents who find circular traps at every turn. This package also examines: * Characteristics of plans that miss the mark * What to do if your health plan … Read more

This page also available in PDF The Health Care Financing Administration confirms that the big upturn in medical inflation almost everyone expects hasn’t yet hit. But the rate of spending in the private sector has increased three years in a row, as health plans try to shore up margins. Color charts SOURCE: HEALTH CARE FINANCING … Read more

Government overpays specialists relative to primary care physicians and thereby exacerbates the shortage of primary care physicians, according to researchers at the Cambridge Health Alliance and Harvard Medical School. The study, released online by the Journal of General Internal Medicine, will be printed in September. The data are from the 2004 Medical Expenditure Panel Survey, … Read more

Management of the uncontrolled asthma patient and case examples Full text in PDF Abstract Allergy is a significant component in many asthma patients. Omalizumab is a monoclonal anti-immunoglobulin E antibody for the treatment of allergic asthma. Clinical trials have shown that omalizumab treatment is associated with improved symptom control and reduced inhaled corticosteroid doses, resulting … Read more

Justices overturn six-month waiting period In a pivotal ruling, the Supreme Court has cut the time it will take for copycat versions of biologic drugs to reach the marketplace, according to a Reuters report. The decision could yield billions of dollars in sales for drug companies. The justices, in a unanimous 9-to-0 vote, overturned a … Read more

Some state officials have real doubts that health plans offer any viable solution to the problem of providing care while budget deficits grow. John Carroll Contributing Editor Late last year, 35,000 Oklahomans on Medicaid were told that they had to get by with a slightly reduced level of health care. Six percent less, to be … Read more

Michael D. Dalzell Genentech is closer to readying obinutuzumab — its heralded next-generation version of rituximab (Rituxan) — for the market. The biotech powerhouse says obinutuzumab bested rituximab in a time-to-progression study of treatment-naïve patients with chronic lymphocytic leukemia. Numbers and details will have to wait for December’s American Society of Hematology meeting, but Genentech … Read more

Predicated on EvaluatePharma’s policy of over 7,000 of the world’s major biotech and pharmaceutical companies, that the Orphan Drug Report 20-19 highlights trends in pharmaceutical earnings of antipsychotic drugs, US expense of therapy, leading goods From the infrequent diseases landscape and orphan drug designation investigation from treatment and region area. Illness. The good results of … Read more

Medical errors are estimated to function as third-highest trigger Of passing in the nation. Pros and patient safety advocates are attempting to improve this. However, at one of many gear that is contemplated that a cure isn’t yet working and it needs to, proposes that a report published Thursday. That is based on this Leap … Read more

A Conversation With J. Lyle Bootman, Ph.D. In his inaugural address as 1999 president of the American Pharmaceutical Association, J. Lyle Bootman, Ph.D., noted that many issues facing pharmacists at the turn of this millennium were present in the year 1000. Four major issues, as recorded in The History of Pharmacy, were the “development of … Read more

Medical Management Group of McKesson HBOC This article also available in PDF Abstract Purpose: Describe patient satisfaction and patient-reported outcomes after voluntary use of a telephone-based nurse triage service. Methods: A random sample of symptomatic callers who contacted the triage service in 1999 was identified. A computer-assisted telephone survey was conducted, resulting in a response rate of … Read more

In the first of several posts, Tom Ewers and Munzoor Shaikh of West Monroe Partners discuss the dynamics of health care payer mergers. Here, they describe how success hinges on several key ingredients in the stages before closing — the pre-close stage. For health care payers, pre-close homework is the most critical factor leading to … Read more

Politics and the upcoming presidential election may very well doom any major patients-rights legislation this year. At press time, a House bill was stuck in a committee meat grinder. The Senate, without a single Democratic vote, passed a Republican-sponsored bill that President Clinton vowed to veto and Vice President Al Gore promised to use against … Read more

P​rivate equity investment in health care has more than tripled over the past decade, and despite a shift to value-based care and uncertainty over the 2020 elections, interest isn’t abating. “Private equity sees lots of opportunity in health care,” says Ben Isgur, the leader of PwC’s Health Research Institute. “There are still a lot of … Read more

The managed care backlash has claimed another casualty: Financial incentives in physician contracts as a means of controlling utilization. Is capitation far behind? Has risk become another one of those “four-letter words”? Utilization-management incentives and global capitation seem to be in retreat. Public distaste for perceived managed care abuses, more government oversight, class-action lawsuits against … Read more

If you’ve ever grumbled about how the press plays up one tragedy while ignoring millions of successes, you won’t enjoy reading this. But you should. There’s a lesson here about managed care’s failure to tell its story effectively. At first I thought the bad buzz I was hearing about HMOs was no more than the … Read more

Capecitabine increased overall survival versus capecitabine at a subgroup analysis of patients with metastatic pancreatic cancer and systemic inflammation at the esophageal stage II re-cap study. We report results from two phase III studies, JANUS inch and also JANUS 2. The main end point has been OS. Results The two studies were conducted after having … Read more

Case management, utilization management, and quality improvement staff members can play an important part in promoting improved care for patients Insurers can help hospitals improve quality through utilization management, but it would mean reaching out in a unique way. Most payers have employees with counterparts on hospital staffs: Both health plans and hospitals have utilization … Read more

The next time Kaiser Permanente comes to CalPERS with its hat in its hand, it may have to be very persuasive. Kaiser’s HMO turned a $56 million first-quarter profit — its first quarter in the black in two years. Kaiser’s turnaround — it lost $881 million in 1997 and ’98 — is due to premium … Read more

Some supplements are eligible for continuing education. These are noted above the title of the supplement. Newest supplements are listed first. All supplements in PDF format. If you need Acrobat Reader to access PDFs, you can download it from Adobe. Immunotherapy for Advanced Prostate Cancer: A Novel Treatment Option to Improve Survival PDF Prostate cancer is … Read more

When Overly Many operation patients return straight back once again to some hospital after having shipped home, the hospital might also be penalized by the national government. However, a new study suggests a number of these socalled Re Admissions aren’t a healthcare facility’s fault. Most Re-admissions were brought on to problems like drug abuse or … Read more

A U.S. government agency, some argue, should be created to rule on usefulness of medications, equipment, and procedures. Britain has just instituted such a system. Frank Diamond Senior Editor “Health Care Should Be More ‘Transparent’” by Regina Herzlinger, PhD “Harness Information To Make Health Care Work” by Uwe Reinhardt, PhD “Something ‘NICE’ Can Come Out Of This” by … Read more

When new pharmaceutical products enter the market, the lack of real-world experience with these drugs creates quandaries for payers and providers alike. Often, all there is to go on is the minimum required for FDA approval—non-inferiority to a comparator product in terms of efficacy and safety. If an existing medicine is less expensive than the … Read more

A surge of new MS treatments have been for the relapsing-remitting form of the disease. A new drug that targets CD20-positive B cells may change that. Therapy for multiple sclerosis (MS) has been on a roll. Since 2009, a steady stream of more effective medications has been introduced for the autoimmune disease that attacks the … Read more

BY JOHN LA PUMA, M.D. Mrs. Chilaca is 67 and has severe peripheral neuropathy from diabetes. She has tried antidepressants, massage, narcotics, anti-inflammatory agents and antiepileptics. She has been to a chiropractor for several adjustments, without success. The only medications she takes are metformin and glyburide. Her examination shows no hair below the knees, poorly … Read more

Medicare considers going beyond palliative care, and Aetna finds that allowing curative treatment and loosening admission criteria reduce costs and improve quality of life Medicare has been credited with a wide range of payment innovations that were later embraced by private health plans, but when it comes to benefit design, most experts think of private … Read more

Obesity is a disorder in which a individual has an unhealthy amount and/or distribution of bodyfat. To measure obesity, researchers typically utilize a scale known as the body mass index. BMI is calculated by dividing a individual’s weight by their height squared. BMI offers a more accurate way of measuring obesity than weight alone, and … Read more

Policy experts see the Canadian system as an example but differ on the significance. Meanwhile, some U.S. providers are cashing in. Interesting things happen to two adjacent countries with dissimilar health care funding and delivery mechanisms: Differences in access and cost of care create individual and institutional anomalies. A case in point: The Organization for … Read more

Adalimumab-adbm Cyltezo, by German family-owned pharma important Boehringer-Ingelheim, is well known for numerous signs for example treatment of adults who have moderate-to-severe rheumatoid arthritis symptoms. Here really is actually the 2nd FDA-approved biosimilar into US-licensed Humira, After Amgen’s Amjevita, that has been cleared for promotion at September 20-16. During March this year, Amgen additionally gained … Read more

Enrollment snags could be just the start of political and regulatory headaches facing health plans and pharmacy benefit managers Medicare Part D, the most significant change in the health care delivery system in decades, resembles a giant squid. The marketing tentacles of 10 national and dozens of regional health plans and pharmacy benefit management companies … Read more

If it has to do with the Triple Aim formula — reducing health expenditures, improving health effects and improving individual experience — that the federal dialog was squarely focused the initial two regions of the equation. But on Capitol Hill, the many”repeal and replace” efforts are overlooking the most obvious focus on replying that which … Read more

Mobile Health: Real Game-Changer Mobile apps, approved by the FDA or not, are already profoundly affecting the management of care Michael Levin-Epstein A Conversation With Delos M. ‘Toby’ Cosgrove, MD: Provider-Side Economics The head of the Cleveland Clinic on consolidating, reducing FTEs, and keeping physicians engaged AHRQ’s Free Research Can Help Plans Anticipate Coverage Issues … Read more

If employers make decisions based on URAC’s and NCQA’s rating of traditional managed care plans, shouldn’t they want similar ratings of CDHPs? MargaretAnn Cross Contributing Editor When health plan accreditation organizations began taking note of emerging consumer-directed health plans in early 2003, the evolving insurance products were difficult to define. Today, as two major accrediting … Read more

One could take the view that by allowing provider-sponsored organizations to become a Medicare+Choice option, the federal government gave physicians, hospitals and other health care providers opportunity and encouragement to assume the responsibility of running a health care system, to integrate the insurance part with the clinical part in a more humane way, and with … Read more

Plan sponsors are wasting $4.9 billion annually as a result of inadequate management of specialty medications in the medical benefit, according to our estimates using MarketScan data. Most of these costs could be avoided by applying the utilization- and trend-management programs that are traditionally found in the pharmacy benefit to the medical benefit, according to … Read more

Provenge is just one example of an expensive biotechnology drug whose survival analyses leave much to be desired John Carroll Contributing Editor When Dendreon won a landmark FDA approval for the pioneering therapeutic cancer vaccine Provenge last year, the company managed to stun some longtime industry observers with the price: $93,000 for a full course … Read more

BY NEIL CAESAR, J.D. Suppose you decide to contract for “designated health services,” such as diagnostic imaging, physical or occupational therapy, prescription drugs or hospital services, that are prohibited under the Stark law. Suppose further that the financial arrangement does not satisfy any of the Stark law’s exceptions. Is there any way you nonetheless may … Read more

Flash-frozen samples of surgically removed breast cancer tissue are the key to measuring a patient’s risk of metastasis Every cell in our bodies contains roughly 25,000 genes. If that is the case, why do we have such widely varying types of tissue, such as the cornea and the fingernail, the nose and the kidney? The … Read more

Hospital readmissions can adversely impact patient and cost outcomes. Predictors of all 30day Re Admissions are primarily diagnosed with medical claims statistics. Listed below are results of someone questionnaire developed as a portion of frequent hospital quality assurance routines. Twothirds of patients reported good release experiences but were readmitted. Onethird of patients discharged had a … Read more

Even the least lethal form of breast cancer can reappear and turn deadly years after a woman’s last treatment, according to a study by Kaiser Permanente. “Impact of Breast Cancer Subtypes and Treatment on Survival: An Analysis Spanning Two Decades,” says that women with luminal A tumors are still at risk for death more than … Read more

The disease management industry worries about a bill sent to California’s governor that would allow medical information to be shared only when a physician authorizes DM services…. The American Osteopathic Association won’t follow the AMA’s lead. It voted not to form a doctor union…. In Washington, where insurers have been dropping individual policies, only one … Read more

Three-tier prescription copayment designs are surging in popularity, according to an analysis by Scott-Levin. As of last fall, two thirds of health plans that offered a prescription benefit had instituted so-called triple copayments. By comparison, 12 months earlier, barely more than half of those plans had three-tier systems in place. The copayments themselves are creeping … Read more

Initial bids are in and it appears that premium growth will be slowing even more in 2007, according to a report by Hewitt Associates. On average, HMOs are proposing to raise premiums 11.7 percent next year. The companies last year initially asked for 12.4 percent increases. Some experts think that the rate increases might wind … Read more

The internationally known health care economist says we have been heading in the right direction all along — we just have to tackle problems in the right order Health care economist Uwe E. Reinhardt, PhD, is bullish on health care. The decline in the growth of health care costs looks as if it is permanent, … Read more

Washington Watch Q: What are the chances that Congress will soon enact legislation that will allow the public to tap into the National Practitioner Data Bank electronically to obtain information about its providers’ professional history and conduct? A: Somewhere between slim and none. Nevertheless, Republican Rep. Tom Bliley of Virginia gave the issue a shove as Congress … Read more

But critics of the Center for Medicare and Medicaid Innovation see too much power and money accruing to the ACA-created skunkworks.   It seems that under HHS Secretary Alex Azar, the Center for Medicare and Medicaid Innovation—that ACA-enabled office given almost carte-blanche authority to experiment with new payment and care models—may be getting its groove … Read more

Would Steve Jobs Have Agreed With an ACO Movement? Submitted by Paul Terry on Thu, 2012-01-12 11:05 Having just finished reading Walter Isaacson’s brilliant rendition of Steve Jobs’s life and career, I’ve considered whether there are health care marketplace lessons to be garnered from his central casting in the extraordinary tech wars for primacy over the past … Read more

Hospitals now face stiff penalties and some health plans see this as a way to attain a long-sought goal A little more than two years ago, Victor Caraballo, MD, the senior medical director at Independence Blue Cross in Philadelphia, set out to hit the brakes on the flow of unnecessary readmissions to area hospitals. By … Read more

Having driven generic utilization about as far as possible, plan sponsors are turning to a method of controlling drug costs that had all but disappeared. Aggressive contracting is driving this trend, but that may soon yield to evidence-based evaluation. If this decade has a feeling of deja vu, well, you can be forgiven. A lot … Read more

With the approval of Breo Ellipta in May 2013 and Anoro Ellipta in December 2013, formulary decision makers are faced with more treatment options for chronic obstructive pulmonary disease (COPD) than ever before. There are now three inhalers that are combination products of a long-acting beta agonist and a glucocorticoid that can potentially help patients … Read more

The National Committee for Quality Assurance plans to offer a snapshot based on its well-known HEDIS report that it hopes will let employers and workers get a quick, but comprehensive, view of how health plans handle four chronic diseases. Plan-specific results on as many as 13 HEDIS measures for diabetes, cardiac conditions, asthma, and mental … Read more

While 99 percent of insured workers have coverage for prescription drugs, how that coverage is distributed differs by plan type. Overall, 78 percent of workers are enrolled in plans with three, four, or more tiers for prescription drugs. That number hasn’t changed from last year, according to the most recent Kaiser Family Foundation report, Employer … Read more

Nights February 6thhe had been at an exceptional place to show a collection damaging stories concerning his superior, Bo Xilai: Bo’s familial relation into the supposed murder of British business man Neil Heywood, siphoning of Chongqing’s public capital, also shakedowns of local offender and also tri-ad elements. Up against the complexity of China’s leadership transition … Read more

Health and Human Services (HHS) just released data on 2010 health expenditures, reporting that we, as a nation, have now reached the $2.6 trillion mark, consuming 17.9% of our GDP. Reaching that new mark required 3.9% annual growth vs. 3.8% in 2009. On the surface, the rate of growth seems less alarming than the insurance … Read more

The typical life expectancy of hospitalized patients with IPF is just 3 to 4 decades. Reduction in forced vital capacity in patients with IPF is apparently nearly linear, together with patients using well preserved FVC at baseline undergoing exactly the exact same speed of reduction in FVC as patients with more complex illness. 2 antifibrotic treatments … Read more

Some insurers and PBMs are experimenting with a pragmatic approach to covering testing Thomas Reinke Contributing Editor Pharmacotherapy biomarkers — those that predict drug response — and their related pharmacogenetic (PGx) tests are seen as the pathway to personalized medicine in cancer and other diseases, but their uptake has met resistance. Often they are supported … Read more

The New Team in Town: Primary Care The May 17 New England Journal of Medicine 200th Anniversary edition article The Evolving Primary Care Physician highlights key structural, financial, and cultural challenges that confront primary care in the United States. Some of these include training and education that emphasizes ever greater subspecialization, reimbursement that rewards volume versus value, and an … Read more

Of an investigational ready-to-use rescue pencil for that treatment of acute hypoglycemia in patients with diabetes. The pencil is really a liquid-stable glucagon Auto Injector, developed with The entire findings of these trials won’t be published until after this calendar year, no matter how the business said that the trials have been a triumph, with … Read more

Use of generic medications continues to increase, according to Express Scripts, the pharmacy benefit management company. More than 50 percent of all prescriptions that Express Scripts fills are for generics. Still, the generic fill rate varies widely across the country, with possible explanations including variations “in prescribing patterns, state regulations, differences in disease prevalence, and … Read more

No longer passive, companies are working in a variety of ways to improve employees’ care. Are health plans being left behind? Helen Darling calls it “revolutionary,” this effort on the part of employers to more closely monitor and improve the health of their workers. Darling, the president of the National Business Group on Health, which … Read more

New Era of Health Care Spending Could Roll Into the Good Times The slowdown in increases often happens during and shortly after recessions, but this time the trend may continue as the American economy perks up Frank Diamond Managing Editor Tweet Widget(link is external) About a decade ago, economists noticed something strange about the rate … Read more

After years of stagnation, organ donations are up, and organizations that collect organs for transplantation and the hospitals they work with say their partnerships have been the key to getting the numbers to grow, according to an article posted on the HealthLeaders Media website. The number of organs from deceased donors rose 5.6% in 2015 … Read more

Physicians who make the move to the administrative side find a lot of tough decisions waiting for them. Marilyn Bydalek Quint Studer tells a story about his first day as the CEO at Baptist Hospital in Pensacola, Fla. back in 1996. When he asked a nurse what he could do to make her job better, … Read more

Too often, society prods regulators into adopting new drugs and technologies without adequate scientific analysis Scope of the argument The pressures for health systems and providers to become early adopters of new treatments and the expectations of patients to have immediate access to the newest therapies continue to raise the question of when innovations become … Read more

Maybe not the least of them is through connections with medical care providers to alter therapeutic and diagnostic conclusions. Since its inception, programmers used the HELP hospital information system to research automatic interventions to the medical decisionmaking process. With their nature such interventions imply that a computer-directed interaction with all the physicians, nurses, physicians and … Read more

Cardinal Health and McKesson see a future in an idea that has had difficulty taking root. Part D medication therapy management (MTM) has been on the road paved with good intentions. MTM services have the potential to do a lot of good by improving medication outcomes, preventing adverse events, and controlling costs. But for the … Read more

Humor depends on truth, and a funny sequence in a currently running situation comedy involves a television executive making a cameo appearance on one of his shows. Suddenly, reflexive actions become an amateur actor’s overdone gestures. When he “walks” into the scene, he resembles the just oiled Tin Man in The Wizard of Oz. Incentives, … Read more

BlueCross BlueShield of North Carolina’s vigorous patient-centered medical home may be an example to other plans and providers Frank Diamond Managing Editor The brave new world of provider-payer cooperation requires an approach that’s somewhat at odds with traditional managed care, says Don W. Bradley, MD, senior vice president for health care and chief medical officer … Read more

System Helps P&T Committees Get Pharmacoeconomic Data They Need The Academy of Managed Care Pharmacy is testing a plan to have drugmakers submit evidence-based outcomes analyses when seeking formulary inclusion. Jack McCain PPO Performance Hard To Gauge; Comparisons to HMOs Not Reliable It’s long been said that PPOs, by their varied nature, can’t be held … Read more

Printer-friendly version Managed Medicare and Medicaid especially struggle to develop improved discharge and follow-up systems While Congress looks to wring billions of dollars out of the nation’s health care system, America’s health insurers believe billions may be saved simply by improving hospital discharges so that patients do not return. Some health plans have been working … Read more

Only small premium rises next season, and a few are certain to get price reductions. That is the judgment in a private investigation of this besieged but resilient app, which sparks deep branches heading into this season’s mid term elections. And the exodus of insurance from this app has stopped, even reversed marginally, with an … Read more

Re-underwriting would be prohibited under a bill introduced in the House and Senate on Oct. 16. Under the legislation, insurers would not be allowed to increase or reclassify premiums “based on a health-status-related factor,” says Sen. Bob Graham, one of the sponsors…. Health benefits for part-time workers were the focus of a labor dispute between … Read more

Addressing the problem of the uninsured remains tricky owing to the fact that the number of those who find themselves in such circumstances for long periods of time varies considerably from the national average of 11 percent, according to the 1999 National Survey of America’s Families. In fact, length of time being uninsured seems to … Read more

A Conversation with Michael E. Porter, Phd, and Elizabeth Olmsted Teisberg, PhD “How could the largely private U.S. health care system, characterized by arguably more competition than any other health care system in the world, be performing so poorly?” Michael E. Porter, PhD, and Elizabeth Olmsted Teisberg, PhD, set out to provide a new way … Read more

Centers for Medicare and Medicaid Services Administrator Thomas Scully has defended the Bush administration’s plan to allow states to opt out of mandatory Medicaid-coverage requirements. The CMS (formerly HCFA) chief, deflecting criticism that states might not use their savings to expand health coverage, says they will be required to plow the money into coverage for … Read more

Pennsylvania has been one of the states hardest hit by the opioid epidemic, with more than 3,500 people dying from the drugs last year. Michael Ashburn, MD, MPH, guest blogs today on the Philadelphia Inquirer’s health section and points out that the epidemic started with the best of intentions: relieve pain. Ashburn blogs: “Over the years … Read more

Lights! Camera! Scalpel? Some employers are experimenting with steering their workers toward Web sites in which they can see videos of actual surgeries. “There is the diabetic foot-ulcer procedure, in which forceps peel away dead tissue as blood drips down the foot,” the Wall Street Journal reports. “There is the skin-cancer footage, in which a … Read more

Over-the-counter medications can be a good thing for the patient, the insurer, and the pharmaceutical company that developed the product Health plans encourage patients to use over-the-counter alternatives to prescription drugs of similar therapeutic value, and, as self-medication is increasingly common in this country, patients are responsive. With 2006 sales of more than $15 billion, … Read more

When it comes to consumer-driven health care plans, many employers aren’t too enthusiastic about them, according to a report issued by the Centers for Studying Health Systems Change, a nonpartisan research group based in Washington, D.C. “There’s a lot of buzz from vendors and consultants about consumer-driven health plans, but many employers are skeptical about … Read more

Is Bundled Payment an Idea Whose Time Has Come? For decades, managed care plans have sought to stop paying fees for services. Now they’re trying bundled payments for episodes of care. Joseph Burns Cloud Computing Puts Stakeholders On Same Page It might not be the road to totally overcoming the fractured nature of the health … Read more

Perinatal quality collaboratives and other responses may help reverse the trend. But payment reform that gets rid of perverse incentives is a prerequisite. In 1960, Singapore’s infant mortality rate was 36 out of every 1,000 babies born alive. That same year the rate in the United States was significantly better: 26 out of every 1,000 … Read more

MANAGED CARE February 2008. ©MediMedia USA Insurers have maintained strong earnings in recent years — much to the delight of stockholders — because of relatively stable expenses, improved case management, and new technology. However, a report by A.M. Best Company, a global credit rating organization, suggests that insurers will need to navigate a challenging financial landscape in … Read more

Most specialties saw modest increases in compensation in 2003, according to the American Medical Group Association’s 2004 Medical Group Compensation & Financial Survey. Cardiologists, dermatologists, gastroenterologists, and pathologists in particular, enjoyed the largest increases in compensation. Median salary for 2002 was $217,652. In 2003, the median salary reported was $237,101. “Last year, we actually saw … Read more

John Marcille We heard a lot about primary care in the early days of managed care. Gatekeepers were supposed to steer patients to specialists only when necessary, and even limit unnecessary treatment. They still do that, but to a much lesser extent. Remember, we also heard a lot about the Patients’ Bill of Rights. The … Read more

Health care premiums for large employers will increase 15 percent on average in 2003 — the biggest year-over-year jump since Towers Perrin began conducting the survey in 1989. “Employees will be paying more out-of-pocket this year,” says Ron Fontanetta, a Towers Perrin principal. “Cost sharing will come in the form of increased monthly contributions, as … Read more

Recession-minded regulators don’t like this year’s proposed rate hikes. Just try telling them that the increases are based on actual rising costs. John Carroll As president of the Retailers Association of Massachusetts, Jon Hurst hears a lot from small-business owners these days about the cost of health care insurance. Under a Massachusetts mandate, employers have … Read more

Michael Levin-Epstein Washington Watch Low reimbursement wasn’t the only — or even the primary — factor behind HMOs’ Medicare pullout last year. The General Accounting Office has concluded that “although an unusually large number of managed care plans left Medicare, a number of new plans have demonstrated their interest in serving beneficiaries by applying to … Read more

Stribild, a four-drugs-in-one agent, makes a once complex drug regimen more manageable with better outcomes A landmark publication from the World Health Organization in 2003, Adherence to Long-Term Therapies, Evidence for Action, brought to light the fact that adherence to long term therapy is not just a problem in the United States but is a … Read more

The cost-sharing techniques that employers use in prescription drug benefit designs vary, but across types of health plans, there is remarkable similarity. For instance: Separate copayment levels for brand-name and generic drugs is the most common technique that employers use, but it’s not necessarily seen more often in an HMO than in, say, a PPO. … Read more

An Analysis of heart failure Could seem daunting, especially when it Comes unexpectedly. But heart-failure is manageable and also, for a lot of , heart failure treatment could be the launch of a fresh, healthiest period of life. That is since the very first step to managing this problem is to produce sure life style … Read more

BY JEAN LAWRENCE Contributing Editor In 1995, Harris Methodist Health Plan, the largest in northern Texas, informed the Fort Worth Clinic and its physicians that they were to spend no more than 9.6 percent of each premium dollar on drugs. If the physicians violated this directive, Harris said, they would have to eat 35 percent … Read more

The U.S. Preventive Services Task Force now published a draft recommendation announcement on screening for esophageal cancer. For first time, the Task Force is recommending that viewing beginning at age 4-5. This is ab recommendation. The taskforce has been highly recommend screening men and women that are 50 to 75 yrs of age. This really … Read more

With federal budgets tightening and the ranks of the elderly swelling, the managed care approach is expected to transform Medicare. What will this mean for HMOs and the physicians they contract with? For the elderly, the face of medical care is undergoing a drastic change. Medicare recipients are joining managed care organizations at a record … Read more

Agonist liraglutide to incorporate language at the prescribing information which the medication can decrease risk for major adverse cardiovascular disease, myocardial infarction, stroke and cardiovascular disease in adults who have diabetes and based CVD, based on some news release in Novo Nordisk. The choice relies on results by the LEADER trial, that revealed a 1-3% … Read more

Two of the nation’s top accrediting bodies and the AMA are cooperating on a plan to coordinate performance measurements. The hope is that the effort will reduce overlap and the expense of data collection and reporting. The AMA, National Committee for Quality Assurance and Joint Commission on Accreditation of Healthcare Organizations have established the Performance … Read more

High Speed Internet Migraine Pain Relief fashion trends Credit Card Application Online classifieds Best Mortgage Rates All Inclusive Vacation Packages Paul LendnerPaul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und Fitness. Er schreibt bereits seit über 5 Jahren für das Managed Care Mag. Mit seinen Artikeln, die einen einzigartigen Expertenstatus nachweisen, liefert er … Read more

Into the debate about the frequency of cancer screenings steps the Gallup Organization, whose survey shows that a majority of Americans are satisfied with how often such screenings occur. Fifty-eight percent think that Pap smears, mammograms, and other screening tests are performed often enough. Thirty-one percent say they are not done often enough, while 7 … Read more

PacifiCare says it isn’t necessarily for sale, but won’t rule one out, either, as it examines “value-increasing strategies.” PacifiCare’s soul-searching, prompted by a 43-percent decline in its stock price this year, officially began on a November day when it shook up management and formed an executive committee to sift the company’s options. PacifiCare President Jeffrey … Read more

Effect of Drug Therapy on HEDIS Measurements of HbA1c Control In Diabetes Patients Nausea and Vomiting of Pregnancy: Cost Effective Pharmacologic Treatments Loss of Confidence in Diabetes Management Evaluation of a Continuous Glucose Monitoring System for Home-Use Conditions Health Plan Joins With Physical Therapy Facility to Manage Back and Neck Pain Capital Health Plan achieved … Read more

Organized oncology isn’t ready to give up on ASP+6 payment for Medicare Part B drugs. But experimentation with value-based pricing has some supporters. Change is hard and often unpopular. Change how people get paid, and they will get up in arms in a hurry. The reaction from oncology groups was overwhelmingly negative last month when … Read more

Target action date is November 2016 The FDA has accepted for review a supplemental biologics license application (sBLA) for the expanded use of etanercept (Enbrel, Amgen) to treat pediatric patients with chronic severe plaque psoriasis. If approved, etanercept would be the first systemic drug with this indication in the U.S. The sBLA, submitted in January … Read more

Legislatures want medical-benefit practices applied to oral drugs provided under the pharmacy benefit, all to keep patients’ costs within reach A little more than four years ago, Oregon became the first state to pass a law requiring insurers to cover oral cancer drugs with a “no less favorable” out-of-pocket expense formula than members faced for … Read more

Although EBM is only just getting started, many people are looking beyond evaluating treatments head to head and considering cost as well Lola Butcher Even as demand for evidence-based medicine reaches a crescendo, a chorus of calls for comparative-effectiveness research is emerging to overwhelm it. Payers, politicians, and policymakers agree that the “E” of EBM … Read more

The United States Preventive Services Task Force has recommended against several screenings, yet health plans are finding that it’s not so easy to just drop coverage Michael D. Dalzell Senior Contributing Editor Once upon a time, we believed that if you stay outside when it’s windy and cold, you’ll get sick; that women should rest … Read more

AHIP, AMA, MGMA and others offer recommendations on just how to improve the process. Some heavy-hitting health care organizations think that the prior authorization process needs improvement, saying that it “can be burdensome for all involved—health care providers, health plans, and patients. Yet, there is wide variation in medical practice and adherence to evidence-based treatment.” … Read more

EMPLOYER INITIATIVES A new urgency means that tiered formularies and higher copayments will become even more widespread, a recent survey indicates. Frank Diamond Senior Editor The nation’s employers want to continue to force workers to take a more active role in the battle against soaring prescription drug costs, according to a recent online survey of … Read more

TOMORROW’S MEDICINE When traditional therapies fail in cancer treatment, turning off a chemical switch may offer hope to the hopeless. Thomas Morrow, MD Recent anticancer therapies have grabbed the headlines. In this month’s Tomorrow’s Medicine, I would like to focus on a new class of drug that offers an option where none existed in the … Read more

Don’t look now but the only thing falling in terms of health care costs seems to be the rate of increase of premiums — good news for employers and other purchasers. Preliminary results from the 2006 Group Health Insurance Survey indicate the lowest average premium increase in seven years. In fact, this is the fourth … Read more

Generic drugs are being dispensed in doctors’ offices by devices that function much like automatic teller machines that banks use, under a program sponsored by Blue Cross Blue Shield of North Dakota. What the company is calling its Generic Delivery Network has been launched in physician offices in Fargo and Grand Rapids with the aim … Read more

Network instability is what happens when providers and health plans part company, or threaten to. Lately, many rifts have been the result of contract disputes, invariably conducted in public. Each side takes out full-page ads in newspapers and buys time on radio and TV to make its case to the public. Consumers get “dueling” letters … Read more

Workers covered by health plans with three or more prescription drug tiers are more likely to have copayments than coinsurance, according to the Kaiser Family Foundation’s “Employer Health Benefits 2012 Annual Survey.” The survey says the average copayment amounts for 2012 in plans with three, four, or more tiers of cost sharing are comparable to … Read more

A majority of patients in consumer-directed health plans do not understand their coverage options and about 20 percent will skip preventive care because of cost, even though the services are free or very inexpensive. Those are some of the findings in a study by Kaiser Permanente Northern California, which found that “consumers rarely understood that … Read more

ABSTRACT: Managed care is stuck in a vendor stage of health care industry evolution that is organized, primarily, to beat back costs through contracted discounts and utilization management. At the same time, the potential exists for an altogether different managed care that is based on a more explicit mission of lowering costs through improved quality. … Read more

Furthermore, modelers are inclined to additional consolidate computerized advancements into how the two patients and workers interface with and inside clinical spaces. So what highlights should medical services architects keep an eye out for in 2018? Planner Jason Carney, accomplice at Conditions for Wellbeing Engineering, imparted his perspectives to Business Property Chief, featuring the business’ … Read more

U.S. spending on diabetes medications galloped to $10.1 billion in 2015, a 30% increase over 2014 expenditures, according to the drug spending report that IMS Institute for Healthcare Informatics released last month. While there is rapid growth in the utilization of all diabetes medications, especially insulins, the spending figure might be misleading because, according to … Read more

In a few weeks, the calendar will tick over and, if we’ve solved our Y2K problems, we’ll be seeing a calendar year none of whose digits will be the same as this year. It will look new (even though we know it’s really the last year of the second millennium) and may invigorate us. A … Read more

The CMO of the nation’s largest pharmacy benefits manager says that the company’s mission has broadened. One new area of focus: worker productivity. Alan T. Wright, MD, MPh, is at the center of efforts by the nation’s largest pharmacy benefits manager, AdvancePCS, to redefine itself as a “health improvement company.” Built through a series of … Read more

The issue of this expanding amount of uninsured affects health care methods. Modified benefits and subsidies in hospitals, physicians and Blue Cross and Blue Shield attracted premiums to degrees less than 1 / 2 of their speed for unsubsidized policy. Steps undertaken at the product’s evolution addressed doctor concerns, and guaranteed doctor involvement adequate to … Read more

Considering that the treatment/test institution is a inseparable Idea, that Is the Reason Why the evaluation is known as “company”, the evaluation of the diagnostic evaluation must be clubbed together with this of this treatment. This involves immediate impacts involving analysis modalities, which is not, to supply the essential demonstrations to meet the degree of … Read more

Research Published Monday finds Similar Security and Efficiency for one Type of biosimilar drugs, complex drugs meant to function as near-copies of a number of their priciest prescribed medication available on the current market, but emphasizes the need to find out more on the merchandise. Biologics are medications derived or made from cells with Cuttingedge … Read more

“Cardinal Health urges, and also the FDA agreesthat clients should immediately discontinue usage of most affected surgical dresses and PreSource procedural packs which have those surgical dresses since the manufacturer can’t offer certainty that the services and products are sterile,” said FDA’s Center for Devices and Radiological Health Director Jeff Shuren. Shuren explained that Cardinal … Read more

It’s one thing to encourage efficiency on the technical side, but do you really want your radiologist to read 50% more scans or X-rays per hour? John Carroll Contributing Editor Just like every other payer in the country, Medicare has been looking for the best approach to reining in the high cost of imaging. And … Read more

Anthem’s Geoffrey B. Crawford Wants To Fix Wellness Programs FRANK DIAMOND The 35-year-old is a rising star in one of the country’s largest health care plans. Included in his take: ACOs hold promise, and gene therapy could break the bank. Fee for Service Is Dead. Long Live Fee for Service? JAN GREENE The move toward … Read more

A recent survey of pharmacy directors in 49 HMOs representing 9.5 million enrollees revealed that most of the plans have now embraced “disease state management” programs. Such programs, often implemented jointly with pharmaceutical companies or pharmacy benefit managers, seek to rationalize management of patients with certain conditions, employing aggressive treatment early to minimize expensive complications … Read more

Name Last modified Size Description Parent Directory 06-Jan-2001 16:01 – 0001/ 15-Mar-2000 21:06 – 0002/ 01-Jan-2001 14:05 – 0003/ 28-Apr-2000 09:13 – 0004/ 01-May-2000 23:41 – 0005/ 08-Jun-2000 12:01 – 0006/ 03-Jul-2000 22:10 – 0007/ 01-Aug-2000 18:24 – 0008/ 04-Sep-2000 22:03 – 0009/ 17-Nov-2000 10:25 – 0010/ 12-Nov-2000 00:36 – 0011/ 01-Jan-2001 12:52 – 0012/ … Read more

Von Willebrand disease (VWD) is distinguished with its own heterogeneous clinical symptom, which disrupts its identification and control. The clinical direction of VWD has stayed essentially unchanged within the previous 30 decades approximately, with von Willebrand factor (VWF) targets, desmopressin and anti-fibrinolytic representatives as chief tools to regulate bleeding. That is compared to hemophilia A, … Read more

The FBI is warning That the healthcare Industry to Measure security of Its Own File transfer protocol servers like cyber-criminals measure up strikes targeting FTP servers running in anonymous manner. “The FBI Knows of criminal celebrities That Are actively targeting FTP Servers operating’anonymous’ manner and related to dental and medical centers to get secure health … Read more

Online or app-based “chatbots” evaluate symptoms 24/7 and could make health care more accessible and effective. But are they just another toy for the tech‑privileged? P​atients who are worried about symptoms in the middle of the night don’t have to run out to an urgent care facility these days or fuss about landing an appointment to … Read more

Democrats in the California Senate last month killed Republican Gov. Pete Wilson’s plan to overhaul managed care regulation. On a party-line vote of 22-15, the Senate rejected a plan to create a Department of Managed Health Care, which means that managed care oversight will remain with the Department of Corporations. Sen. Herschel Rosenthal, a Los … Read more

Washington Watch Get any mail about the Financial Services Modernization Act? You’re not alone. Insurers and financial institutions are flooding customers’ mailboxes about their rights to protect medical and financial information under what’s better known as the Gramm-Leach-Bliley Act. But just how GLB will affect health plans isn’t totally clear. GLB requires affected institutions to … Read more

Florida regulators last month ended a nearly 1.5 year-long effort to save Health Plans of America from its financial woes, and shut down the Maitland-based HMO. The plan was partly a victim of its success, at least in selling itself. The state blamed the plan’s collapse mainly on explosive enrollment growth, from 3,000 to more … Read more

Almost 90 percent of Americans know that antibiotics can treat bacterial infections, but a third also believe that they can fight viral infections as well, according to a poll done by the Pew Charitable Trusts for the Centers for Disease Control and Prevention. This type of information is followed closely by public health policy experts … Read more

The perception that DM is merely a drug marketing tool seems finally to have vanished from this healthy, though fragmented, industry. BY STEVE HEIMOFF In 1993, Eli Lilly announced it was turning itself from a drug company into a disease management company. It wasn’t long before other pharmaceutical giants, including Merck, Glaxo, Pfizer, and SmithKline … Read more

Name Last modified Size Description Parent Directory 11-Jan-2005 13:10 – ../../../archives/0001/0001.compmon.gif 01-Jan-2000 12:00 39k 0001.compmon.html 07-Jun-2003 12:33 2k ../../../archives/0001/0001.compmon.pdf 01-Jan-2000 12:00 42k 0001.contents.html 09-Apr-2003 23:25 3k ../../../archives/0001/0001.cover.jpg 01-Jan-2000 12:00 10k 0001.dmpac.chartpac…> 01-Jan-2000 12:00 12k 0001.dmpac.chartpac…> 01-Jan-2000 12:00 15k 0001.dmpac.chartpac…> 01-Jan-2000 12:00 15k 0001.dmpac.chartpac…> 01-Jan-2000 12:00 16k 0001.dmpac.chartpac…> 01-Jan-2000 12:00 8k 0001.dmpac.chartpac…> 01-Jan-2000 12:00 7k 0001.dmpac.chartpac…> … Read more

From the constantly Altering healthcare Arena, one in which Policy makers are funneling hospitals, health care groups, and integrated health systems to some world in that they need to simply take more risk for his or her individual inhabitants, the pressure is mounting on providers to deliver superior outcomes. Really, within the last several months, … Read more

MANAGED CARE October 2011. ©MediMedia USA Many currently marketed antidepressants will be falling off the patent cliff soon. Nonetheless, the antidepressant market is set for steady expansion, according to Datamonitor, a drug information company. The company compiled data from seven major markets for this drug category and found total sales to be $10.9 billion in 2010. By … Read more

Overlooked in the recent concern over the measles outbreak in the United States is the fact that this is a worldwide problem that requires a worldwide solution, says health care journalist Faye Flam. Writing in Bloomberg, Flam points out that this year Madagascar saw a huge outbreak of the disease that killed 1,200 children. (To put … Read more

The French wellbeing unites worldwide policy with a people –private mixture of hospital and healthcare and a bigger amount of service supply compared to at the USA. Even though system is not even close to perfect, its own indications of health status and user satisfaction are high; its own costs, as a share of gross … Read more

Nearly 60 health plans have signed on as “early adopters” of the care management and health improvement standards newly updated by the National Committee for Quality Assurance. They are part of NCQA’s Quality Plus Program, which allows NCQA-accredited plans to pursue additional distinction in selected areas by meeting tough new standards even before they become … Read more

Managed care administrators needn’t have Socialist-realist nightmares of massed doctors on the march–not yet. But some physicians have reacted to today’s business pressures by organizing labor unions. Labor Unions For Physicians: An Idea Whose Time Is Coming? To most people, the idea of class struggle conjures up anything but the image of downtrodden physicians. And … Read more

Health plan offers different cost guarantees in its No Worry and SmartResults consumer-directed programs Frank Diamond Humana is a forward-reaching company in the way a tree stretches toward the sun with roots firmly planted. The company has been getting some attention for programs that allow employers to sign up for multi-year contracts. Those programs — … Read more

Population management claims: The Seven Rules of Plausibility provide means to test the claims of population management vendors. With case studies and commentary. Al Lewis President, Disease Management Purchasing Consortium About this article Al Lewis has been a thorn in the side of the disease management industry for years, and with his new book, Why Nobody … Read more

Competitors are coming together to see if they can leverage blockchain’s magic to solve big problems. Provider directories are among the first use cases. Mike Jacobs works in technology engineering at Optum, UnitedHealth Group’s technology and health care services unit. Kyle Culver has a similar job at Humana. UnitedHealth and Humana are competitors, but now … Read more

Two of the country’s leading nonprofit HMOs, Kaiser Permanente Northwest and Group Health Cooperative of Puget Sound, will be working more closely together than ever before, with an actual merger among the possibilities, officials of the companies have announced. The boards of directors from both companies could reach a decision by November. The combined company … Read more

When we parted last issue, memories of the November government shutdown were fresh. Official Washington eventually lurched to its feet again in the wake of a second shutdown-cum-blizzard that paralyzed the city for nearly a month. In a 30-day period ending in January, federal workers in Washington were at their desks a grand total of … Read more

QUALITY MEASUREMENT It’s long been said that PPOs, by their varied nature, can’t be held to the same quality yardsticks as HMOs. Yet, in time, something will have to suffice. Michael Levin-Epstein Contributing Editor There are more Americans enrolled in PPOs than in HMOs and indemnity coverage combined. Yet while HMO performance largely has been … Read more

Washington Watch A lot of Medicare HMOs’ marketing materials don’t cut it, says a report by the Office of the Inspector General. It adds that the Health Care Financing Administration is partly to blame. While HCFA’s Medicare Managed Care National Marketing Guide, which health plans use to prepare their own marketing materials, has improved some … Read more

FDA Handling of Avastin Discourages Innovation Submitted by Robert Goldberg on Tue, 2011-11-22 19:20 Avastin cancer drugs evidence FDA Robert M. Goldberg is a co-founder and vice president of the Center for Medicine in the Public Interest (CMPI). Robert M. Goldberg, PhDThere has been a lot of discussion of the Food and Drug Administration’s decision … Read more

STATE INITIATIVES The Minnesota Physician-Patient Alliance last month charged the state’s three largest HMOs with spending up to 38 percent of total expenses on administration and other non-medical items. The HMOs–Blue Plus, Medica and HealthPartners–contend that the number is actually about 10 percent, and claim that they are highly efficient. Part of the discrepancy is … Read more

Applying the ACO Frame to Medicaid runs Directly into a Struggle: the disproportionate Effect of socioeconomic factors on health in the Medicaid Populace. Bad health effects one of low carb inhabitants are usually exacerbated by shaky housing and employment, transport difficulties, and insufficient access to food that is wholesome. Insert at a high incidence of … Read more

Americans spent 34 percent more for specialty anti-inflammatory agents used to treat rheumatoid arthritis in 2005 than any other specialty drug category. The specialty anti-inflammatory class had the highest per-member per-year (PMPY) expense of all specialty classes, according to the Specialty Drug Trend Report from Express Scripts. The class, comprising four agents — Enbrel, Humira, … Read more

Converging forces are an economic train wreck waiting to happen. Avoiding a disaster requires an understanding of the interconnection of health care’s stakeholders and the global consequences of their actions. The cost of our health care system is spinning out of control and no one is applying the brakes. While many “solutions” are being offered, … Read more

First advance in therapy for soft tissue cancer in decades   July 21, 2016 Adding a novel monoclonal antibody therapy to traditional chemotherapy increased median survival by nearly a year in patients with advanced sarcoma, a lethal soft tissue cancer. Findings from a multicenter clinical trial of the combination therapy, led by researchers at Columbia … Read more

About 50 of the largest U.S. employers plan to form a health insurance pool for about 4 million part-time, temporary, and contract employees who lack coverage. The pool will also cover early retirees and former employees who have exhausted their COBRA coverage, as well as children of employees who are students but no longer qualify … Read more

Poor financial performance associated with risk contracting between medical groups and insurers appears to be a thing of the past, according to “Capitation and Risk Contracting Survey” from ECG Management Consultants and the American Medical Group Association (AMGA). More than half of medical groups characterized their organizations’ financial performance in risk contracts over the past … Read more

BY TIMOTHY KELLEY Editors have the damnedest preconceptions. When I was a reporter for my college newspaper in Chicago, I was sent to cover a demonstration at a hotel where President Lyndon Johnson was scheduled to speak. The editor was infatuated with the notion of LBJ “eluding” antiwar protesters to enter the hotel, so he … Read more

The cost of treating stroke victims will soar in the next two decades, according to a study by the American Heart Association and the American Stroke Association that was published in the journal Stroke. Real total direct annual stroke-related medical costs are expected to increase from $72 billion to $183 billion (2010 dollars) between 2012 … Read more

Only one in five people have comparison-shopped for health care Historically, the U.S. health care system has not made it easy for people to find out how much their care will cost them out of pocket. Public Agenda, with support from the Robert Wood Johnson Foundation and the New York State Health Foundation, recently conducted … Read more

Contractor has challenges to overcome in turning a dead parrot into a phoenix. The GOP’s assault on big government finally claimed a notable takedown when the government-sponsored website that provides context on a multitude of clinical care guidelines went as dark as an off-Broadway flop. To paraphrase John Cleese in Monty Python’s legendary “Dead Parrot” … Read more

Managed care owes much of its financial success to the “gatekeeper” system. But some health plans are tinkering with that model in hopes of providing care even more cost-effectively. See also: ‘MAKE GATEKEEPERS TRUE INTEGRATORS OF PATIENT CARE’, an accompanying story in this issue Patients enrolled in Long Island, N.Y.-based MDClassic HMO don’t need a referral … Read more

Consultants predicted it would be a major business. Large employers and insurers were experimenting with it. But medical tourism has not lived up to the heady expectations. The ACA and moderation of increases in health care costs cooled off interest. Besides, who really wants to go to an unfamiliar place for health care? Denver businessman … Read more

Formulary Decisions Without Comparative Effectiveness Research Anonymized patient-level longitudinal data better supports formulary policy and coverage decisions, the authors say The United States pharmaceutical market is forecast to grow at a compound annual growth rate of 3.7% from 2013 to 2018. It has been suggested that comparative effectiveness research (CER) may improve the management and … Read more

Our last two columns discussed ways physicians may share information among themselves and with purchasers without running afoul of antitrust law and other legal rules. This month we explore how to keep shared information confidential. The attorney-client privilege protects certain communications between an attorney and his or her clients. When it is in place, no … Read more

HIV: A Fragile Population Enters Managed Care The ACA is moving people with HIV into Medicaid and commercial health plans. Disruption of care can be bad news for people with HIV and for payers. Michael D. Dalzell A Conversation With David J. Brailer, MD, PhD: A New Age for IT The former national health technology … Read more

The Academy of Managed Care Pharmacy thinks there’s a better way for health plans and pharmacy benefit managers to make formulary decisions than by simply looking at line-item budget figures. AMCP will test a set of guidelines for pharmacy and therapeutics committees to follow when adding or removing products from formularies. Intending its guidelines to … Read more

Safer care Re: “Improving Care — 3 Success Stories,” March 2011. These examples demonstrate that focusing on care improvement as a primary goal can lead to both safer care and meaningful savings. This is important to health plans for two key reasons: It shows how plans can accomplish the triple aim of health care reform as … Read more

Washington Watch The Senate debate over the Patients’ Bill of Rights made for great theater, but was the outcome ever in doubt? By the time Vermont Sen. Jim Jeffords defected from the Republican party, the handwriting was on the wall; not only had the Democrats seized the power to set the Senate calendar — they … Read more

Machine learning is currently Out pacing humans in regards to forecasting certain ailments such as cardiovascular problems and diabetesand the ones calculations are very likely to become more accurate with all the capacity to variable privately data recorded on smart phones and wearables. Comparatively, recommendations employed by cardiologists to predict someone’s risk of cardiovascular illness … Read more

It’s Hard To Not Take Diabetes Personally Health Plans Are Ill-Prepared for Looming Diabetes Epidemic The problem is outpacing insurers’ resources and perhaps even their commitment. Can the chronic care model help? New Treatment Approaches To Diabetes The goal of diabetes management is maintaining glycemic control while targeting quality of life improvements Effective Ways To … Read more

I don’t want to sound naive, but a fundamental characteristic of democracy is that we work out solutions to problems in such a way as to benefit the entire society, meanwhile protecting the rights of minorities. When you read Peter Wehrwein’s cover story on legislative intrusion into health care insurance, you’ll get a broad picture of the … Read more

For 28 Years … The Leading Voice in Managed Care In-depth reports, original research, news, Q&As; with nationally respected health care leaders, and expert commentary on the latest developments in medicine, pharmacy, and biotechnology in relation to managed care. Managed Care delivers high-interest full-length articles and shorter features on clinical and business aspects of the industry. … Read more

Costs and Benefits of Bundled Community-Based Screening for Carotid Artery Stenosis, Peripheral Artery Disease, and Abdominal Aortic Aneurysm Steven M. Weisman, PhD Independent Consultant; Morristown, N.J. Elizabeth A. Brooks, PhD Independent Consultant; Asheville, N.C. PDF version:  MC_1501_screening.pdf ABSTRACT Purpose: Perform an initial formal assessment of the costs and benefits of bundled cardiovascular screening. Primarily, determine the … Read more

Whereas before insurers used to devise new products and processes to attract purchasers, now more and more employers are going to the plans and insisting on preventive care   Employers may indeed be shifting insurance costs to employees, but many are also taking greater interest in their workers’ health. Encouraged by public health officials, these … Read more

NEWS & COMMENTARY Race trumps region when it comes to which people with diabetes might be more at risk of having a leg amputated, according to the latest installment of the Dartmouth Atlas of Health Care Series. The raison d’être of the series is to measure practice variation variation across the country. However, this report … Read more

The medical home model for delivering health care is getting tested for people with mental health problems. Missouri has been a pacesetter. Providers often get frustrated when called on to care for the mentally ill, says Joseph Parks, MD, of the National Council for Behavioral Health. “They’re more difficult to engage and to communicate with.” … Read more

Caregivers Fill Crucial Role But Don’t Get Much Help Their care of loved ones defrays costs that would otherwise have to be borne by the health care system, but they too often go it alone.   Susan Ladika Anna Boyle is struggling to figure out how to care for her mother. After a string of … Read more

Women who are enrolled in Medicare HMOs and who are diagnosed with breast cancer are more likely to be diagnosed at an earlier stage than women covered by fee-for-service Medicare, according to research in the Journal of the American Medical Association. A National Cancer Institute/Health Care Financing Administration study of 22,000 women with breast cancer … Read more

Physicians Say Quality of Care Declining Despite advances in medicine, a majority of physicians in the US and a large percentage of doctors in major industrialized countries say that the quality of care they are able to provide patients has deteriorated over the past 5 years, according to survey results released Thursday morning. [Reuters via … Read more

Undertreating childhood obesity may be tied to payment codes, and specifically the perception of pediatricians that the ICD-9 diagnosis code for obesity (278.00) is not covered and that using it will result in nonpayment of services, according to Sarah Hampl, MD, assistant professor of pediatrics at the University of Missouri-Kansas City School of Medicine. Hampl … Read more

Red states aren’t the only ones that might seek ACA waivers John Carroll When Peter Shumlin was running for governor of Vermont last fall, the Democrat vowed to create a single-payer health care system that would replace the employer-based benefit that provides coverage for a majority of the state’s residents. Now that he’s in office, … Read more

A recently issued brief from the Henry J. Kaiser Family Foundation seeks to characterize and analyze persons who frequently, or infrequently, use hospital emergency departments (EDs). The report, titled “Characteristics of Frequent Emergency Department Users,” found that frequent users, those who had four or more visits over two years, often belong to groups with greater … Read more

As some pretty costly, yet very useful, drugs are introduced, will new formulary designs deny access to needy patients? Last year, one of the managed care clients that works with the advisers at Towers Perrin had a single member whose drug bill topped a million dollars. It’s the kind of money that quickly captures a … Read more

For all the talk of change in the state of California’s ability to govern health care delivery, it appears that one group — physicians — is falling through the cracks. California passed a series of health care reform bills last year, including a measure that established a Department of Managed Care to oversee health plans … Read more

We hope that the big “2009” on our cover caused you to pause. To be sure, it’s an odd benchmark, even if it is a half-decade away. Goalposts placed five years apart hold a certain credence for those of us who spent our childhoods doing school drills in which we hid under desks. The “other … Read more

The biggest organizations involved in the health care system should lead the changes that are inevitably coming, says KPMG, the accounting, tax, and consulting firm. “Organizations are clearly considering the effectiveness of their fee-for-service business models, but migration to more value-based models will take some time, and will include a mix of old and new … Read more

Chronic Fatigue syndrome is a intricate disease characterized by clinically and psychiatrically unexplained relieving fatigue that’s not alleviated by rest and can be combined with symptoms of protracted post-exertion malaise, unrefreshing sleep, diminished concentration or temporary memory, joint or muscle pain, pain, sore throat and tender lymph nodes. CFS affects atleast four million adults in … Read more

Despite its widespread usage because the concept had been introduced with David Truman (1951. The Governmental Process. New York: Alfred A. Knopf), counter-mobilization by coordinated interests has stayed ambiguous and infrequently studied . We fully develop the idea of shortterm counter-mobilizationand distinguish it from chronic counter-mobilization, define the terms under which we could see shortterm … Read more

A Kaiser Family Foundation report examining the cost implications of giving Medicare recipients coverage options has found that there are “no obvious ‘right’ choices for beneficiaries.” The report, Paying for Choice: The Cost Implications of Health Plan Options for People on Medicare, estimates a range of spending for three different prototype beneficiaries in eight markets. … Read more

Despite the extensive attention paid to consumer-directed health plans, a survey conducted by the Kaiser Family Foundation shows that these types of plan arrangements have made only small inroads in the employer market. Such plans cover about 5 percent of all covered workers, which is not statistically different from the 4 percent share recorded in … Read more

Seeking the best return on shared-savings programs such as PCMHs and ACOs, health plans are investing cash and other resources to attract and hold patients’ attention Joseph Burns Contributing Editor Have health insurers taken a lesson from Yogi Berra? In a television commercial, the former Yankees catcher and manager outlines a certain insurer’s strategy, saying, … Read more

Health plans play a key role in data quality and will benefit from improvements E-prescribing is growing rapidly, according to Surescripts, an intermediary that routes prescriptions from prescribers to pharmacies, but this technology faces important challenges in streamlining work flows and producing high-quality data. Experts at the American Pharmacists Association (APhA) cite problems in the … Read more

There are many genetic mutations attributable to the condition, but Kalydeco can significantly help a specific subpopulation of patients I can still remember the anguish on the faces of parents whose children were being treated for cystic fibrosis (CF) during my training at a children’s hospital in the late 1970s. They knew that we had … Read more

Longer Pregnant girls expired, experienced complications delivered still born babies through the outbreak compared to in preceding decades, in accordance with a investigation of 40 studies from 17 states published on Wednesday from the journal Lancet Global Health. Pregnant Ladies face an increased threat of acute disease and death if infected with the coronavirus. However, … Read more

Theranos CEO Banned From Operating Lab for Two Years CMS drops hammer on beleaguered company   Embattled blood-testing company Theranos has received notice from the Centers for Medicare and Medicaid Services (CMS) regarding the imposition of sanctions arising from a 2015 evaluation of its laboratory in Newark, California. Among several rulings, the CMS has banned … Read more

Medicare+Choice may be the first wave in a movement to base payments on risk adjustment. But even advocates admit the technology’s weak. So much of the fairy tale called “progress” involves Technology leading Demand to a clearing in the woods, where appears the magic maguffin. “This is what you want,” Technology says. But is it? … Read more

Pay tied to performance has become the norm outside of managed care. Now, the industry wants the same for its captains. John Carroll Contributing Editor Ask Milton Wood about executive compensation in managed care these days, and you hear a lot about metrics. For 33 years, he says, his company — M. Wood — has … Read more

Washington Watch Now that 2000 is so close, we’re done with Y2K worries, right? Not exactly. Federal authorities are concerned that, despite continuing efforts, some state Medicaid programs may not yet have resolved all their Y2K problems. The dangers include a massive disruption in providing services, including payments to providers and determination of applicant eligibility. … Read more

Labor Unions for Physicians: An Idea Whose Time is Coming? Medicine may seem an unlikely occupation to be represented by the union movement. But under the pressures of managed care, some doctors are thinking of themselves as “labor”–and acting accordingly. A SPECIAL SUPPLEMENT TO MANAGED CARE: What Health Plans Should Know About Clinical Practice Guidelines … Read more

Eight of the country’s largest companies have created a group whose purpose is to exhort employers to insist on safe medicine when doing business with health plans, and to encourage workers to use hospitals with good safety records. The Leapfrog Group grew out of the Institute of Medicine’s report detailing medical mistakes in hospitals. The … Read more

Sulfonylureas are cost-effective and also may be the only oral agents that inhibit processes inducing hyperglycemia by improving insulin secretion and insulin resistance. New long-acting agents hold even greater promise. Udaya M. Kabadi, MD University of Iowa Hospitals and Clinics Full text of this article is available in PDF. Abstract Diabetes exacts an enormous toll … Read more

Insurers know that the new tests can be valuable, but have trouble evaluating them and may not even know exactly which ones they are paying for While much has been written about the promise of new molecular and genetic diagnostic tests, they also bring a tidal wave of complexity, cost, and quality issues for health … Read more

Facing significant increases in health-benefit costs, employers appear less willing to bite the bullet than in the past — and are passing many of those increases on to workers. As the cost of coverage crept upward during the last three years, a tight labor market and recruiting pressures led many companies to shield employees from … Read more

Online tools and an emphasis on patient-provider communication encourage more utilization of preventive medicine Aetna officials didn’t exactly cry “eureka!” when they released results of a study of their consumer-directed health plans, but they were proud of the results: Employers that replaced traditional PPOs with Aetna’s HealthFund plans saved $22 million over five years for … Read more

A Protocol for supporting transformation into some unified formulary at the purpose of a telephone reverse request raises formulary compliance prices and also reduces drug expenses. Patients that fall to convert medications tend to be not as inclined to want to trust their own physician. Over The previous two years, prescription medication costs have included … Read more

In January, a new venture investment fund opened in Boston with $42 million in its pocket and a goal of raising $80 million within two years. The new fund, called the JDRF T1D Fund, quickly invested in three early-stage start-ups. Just like traditional venture capital funds, the T1D Fund plans to work closely with start-ups … Read more

Also available in PDF Managed care companies have long endured complaints about preauthorization, utilization review, and provider-panel credentialing. Provider complaints have resulted in individual and class-action suits typically seeking large monetary awards and changes in managed care business operations. Even when MCOs prevail, they spend vast amounts of time and money defending themselves. The U.S. … Read more

Insurers that charge higher copayments for less-useful treatments could improve care and save money, says a new study by Michael E. Chernew, PhD, a professor of health care policy at Harvard University. Chernew and colleagues propose an approach in which copayment rates are based on the value of clinical services (benefits and costs) — not … Read more

Valeant Pharmaceuticals International Inc.’s experimental medication to treat psoriasis needs to be approved for as long as sure measures are set up to mitigate the probability of suicide, an advisory committee into the U.S. Food and Drug Administration reasoned on Tuesday. There were just six suicides across all apps: four psoriasis research one at a … Read more

“The high cost of prescription drugs is a crisis,” says Maine Senate Majority Leader Chellie Pingree. “Working people tell us they make a difficult choice between filling their prescription or buying food or heating oil — or, in many cases, going broke.” Pingree is the primary sponsor of Maine’s Act to Establish Fairer Prescription Drug … Read more

Requiring hospitalization in adults with recognized cardiovascular illness. “Now’s “Praluent has recently helped many individuals lower their ldlc levels, also this brand new sign stipulates a chance to help ideal patients by lessening the probability of acute, lifethreatening cardiovascular disease, including heart attacks and stroke” Top Adults who undergo a heart attack or stroke possess … Read more

Within our past edition of this EYE eat up we moved over outward symptoms and causes of dry eye disease and touched on treatment choices. Still another remedy revolves round diminishing or eliminating potential ecological instigators of dry eye disease. Dusty surroundings, for example sawdust or sand loaded surroundings are timeless places which result in … Read more

Pharmaceutical manufacturers pay rebates to pharmacy benefit managers and health plans as part of their formulary contracting agreements. The “2010-2011 Prescription Drug Benefit Cost and Plan Design Report” says that rebates are calculated as a guaranteed amount per prescription or an actual amount per prescription. The report says that there has been an increase in … Read more

Highmark’s CMO seeks new and improved models of health care delivery Health care reform gives insurers more incentive than ever to look for ways to help physicians improve quality and provide more efficient care, and Pittsburgh-based Highmark is exploring as many approaches as possible to making that happen, says Donald R. Fischer, MD, MBA, senior … Read more

It is customary to think of this payment method as a cost-control mechanism, and it is, but it can raise quality of care too Why don’t we make more payments for entire episodes of care instead of paying for each step? Shouldn’t we pay for results, not for process? The concept of a bundled payment … Read more

Bob Carlson “Physicians are always amazed when I tell them that only 50 percent of their work day is productive time,” says Sherry Delio, an expert in clinical practice work flow and efficiency. “They say, ‘I can’t believe that. I worked all day.’ I say, ‘Yes, but you had a lot of waits and delays.’” … Read more

Last year, the Bureau of Labor Statistics, the statistical arm of the Department of Labor, estimated that pharmacist employment was expected to grow by 22 percent between 2006 and 2016. This year, the forecast is somewhat lower, but still hopeful. The BLS reports that pharmacist employment is expected to grow by 17 percent between 2008 … Read more

One important way that we can improve care for people with chronic diseases is to have medical records that are online and accessible when needed. Jack Ebeler Nearly a decade after Americans’ initial encounters with the Internet, and not long after President Bush called for every American to have an electronic medical record by 2012, … Read more

The former speaker of the house strongly favors a free-market overhaul of the system that would change the way consumers behave. Should you worry? ‘Nobody washes a rental car’ – Managed Care‘s Q&A with Newt Gingrich No one has ever called Newt Gingrich feckless. The former speaker of the House of Representatives fell off the … Read more

MANAGED CARE April 1997. ©1997 Stezzi Communications At a glance California Consumer Health Scope www.healthscope.org Developer: Pacific Business Group on Health, San Francisco, regional employer health coalition Goal: Provide comparative data on health plans and hospitals, as well as general health care information, to consumers Strategy: Establish World Wide Web site, use employee newsletters to build awareness of site To … Read more

By KAREN DONELAN, SC.D. The recent profusion of health care public opinion surveys hasn’t quieted debate over the public’s level of essential satisfaction with managed care. Different headlines trumpet different conclusions. As a health care survey professional, I’d like to suggest some ways to make sense of opinion surveys that appear to conflict, and to … Read more

Predictions of a Doctor Deficit continue to Rise and the COVID-19 pandemic will probably have short and longterm effects on the doctor work force. The company’s 20 20 upgrade was ready ahead of the COVID-19 Emergency, or so the report doesn’t incorporate some particular info or scenarios centered on that catastrophe. “The difference between the … Read more

Training left physicians unprepared for market-based medicine. Doctors can compete by understanding forces that determine any industry’s profitability. In times past, medicine was Camelot and physicians its kings. No longer. While American medical training is generally regarded as the best in the world, it was not conceived with the idea that physicians lead health care … Read more

Unfortunately, most contracts practically invite the companies that health plans deal with to manipulate prices Specialty drugs are generally defined as high-cost prescription drugs that treat complex conditions and require special handling and administration. However, the most striking aspect of specialty drugs is that few payers are effectively controlling their costs. Any payer — whether … Read more

var Drupal = Drupal || { ‘settings’: {}, ‘behaviors’: {}, ‘locale’: {} }; // Allow other JavaScript libraries to use $. jQuery.noConflict(); (function ($) { /** * Override jQuery.fn.init to guard against XSS attacks. * * See http://bugs.jquery.com/ticket/9521 */ var jquery_init = $.fn.init; $.fn.init = function (selector, context, rootjQuery) { // If the string contains … Read more

Visits to retail clinics grew by a factor of four from 2007 to 2009, with patients getting preventive care during hours that most physician offices are closed, according to a study by Rand. The study also compares data from those years with an earlier study of retail clinic visits from 2000 to 2006. “Preventive care … Read more

Cover Story MANAGED CARE April 2012. ©MediMedia USA To paraphrase Mark Twain, the death of the health insurance industry has been greatly exaggerated. Plans simply have to develop new business models. Joseph Burns Contributing Editor Experts predict the end is near for health insurers. In an article in the New York Times on January 30, Ezekiel J. Emanuel, MD, … Read more

Researchers at the Icahn School of Medicine at Mount Sinai say that tiny doses of a cancer drug may stop the uncontrollable immune response to infection that leads to sepsis and kills up to 500,000 people a year in the U.S. The new drug treatment may also benefit millions of people worldwide who are affected … Read more

Health Plans Cautiously Optimistic as ACOs Enter Prime Time Leaders of managed care and of many provider organizations find that they can work together better than ever before A Conversation With Herb Fritch: A Steady Approach to Medicare Advantage Physician buy-in and an innovative payment model will keep Cigna’s HealthSpring on course in a changing … Read more

Countdown Nears for Launch of ICD-10 This new code set promises to delineate like never before the type of physician service rendered Frank Diamond Price Hikes Spur Part D Debate As premiums soar, the new Democratic majority weighs the benefits of restrictive regulation vs. the free market John Carroll Health Insurers Well Positioned, But Must … Read more

A new model of care developed by the American Academy of Family Physicians places primary care physicians back at the center of care delivery Martin Sipkoff Contributing Editor Primary care physicians have long complained that they suffer at the hands of health plans. What they see as inadequate payments and their belief that plans want … Read more

Fifty-nine percent of prescriptions for mental health medications are written by family physicians, not mental health specialists, which raises concern about the quality of some treat ments, a new study indicates. The research, conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) and Thomson Reuters, examined 472 million prescriptions written for psychotropic drugs … Read more

Primary care physicians enjoyed a 4 percent increase in compensation in 2006, less than the aggregate of medical and surgical specialties, which had a 6 percent increase, according to the American Medical Group Association. But if you look at the graph below, you’ll see that over the three years ending in 2006, primary care specialties … Read more

Insurers should like contraceptives. They prevent expensive unintended pregnancies. But the rollout of ACA-mandated coverage has been bumpy. It’s been almost four years since the ACA’s contraceptive coverage requirements kicked in, and women have benefited from broader coverage and lower out-of-pocket costs for birth control. But that doesn’t mean this provision of health care reform … Read more

President Trump said Monday he would talk vaping-industry agents as he chose which will pub earnings of candy, fruit-flavored e cigarettes targeted toward young men and women, increasing concerns among public health urges the step might possibly be diluted. “will be meeting representatives of this Vaping industry, along with doctors and respective nation agents, to … Read more

Just What Causes Health Care Inflation?   Aging of the population and increased demand for services are not why costs have risen so quickly in health care, according to a study in the Journal of the American Medical Association. “Between 2000 and 2011, increase in price (particularly of drugs, medical devices, and hospital care), not … Read more

Thomas Morrow, MD The less common form of hemophilia — acquired hemophilia — can now be treated with recombinant activated factor VII MANAGED CARE January 2007. ©MediMedia USA The less common form of hemophilia — acquired hemophilia — can now be treated with recombinant activated factor VII Thomas Morrow, MD Hemophilia is typically thought of as an … Read more

Health plans can position themselves even before talks begin by getting all the information they can on the population they wish to target. The saying that the three most important things to consider when buying a house are location, location and location can be tweaked a bit and applied to the process of purchasing a … Read more

The National Committee for Quality Assurance and the AMA hit upon an agreement intended to reduce paperwork for physicians. NCQA will allow health plans to use data from AMA’s American Medical Accreditation Program to satisfy NCQA’s credentialing standards. Though only a smattering of health plans use AMAP physician-credentialing standards, the AMA expects many more to … Read more

The Health Care Financing Administration has given Medicare+Choice plans an extra two months to decide benefit packages and pricing for 2000, extending the deadline from May 1 to July 1. Last year, plans complained that the May 1 deadline didn’t give them time to determine current-year trends — forcing many to abandon Medicare. Meanwhile, the … Read more

MANAGED CARE October 2001. ©MediMedia USA In past years, the National Committee for Quality Assurance has used the annual release of its “State of Managed Care Quality” report to goad health plans into better HEDIS performance. Plans that do well are stroked; minimal improvement is called not good enough; and those that do not participate … Read more

Coronavirus Outbreak News: 17 dead, 500 infected, 3 Chinese cities in lockdown Virus may have originated in snakes, say researchers Another Podcast? But Tradeoffs Is Definitely Worth Your Time. Host Dan Gorenstein was the senior health care reporter on the Marketplace radio program Medicaid: SDOH, Most Def. Direct Involvement in Housing? Don’t Go There. Health … Read more

A program by a Medicaid insurer keeps in touch with patients throughout their entire episode of care Like clinical executives everywhere, Andrew Bergman, MD, the chief medical officer of Amerigroup Maryland, says that he keeps an eye on emergency room utilization. But it’s of even more concern to Bergman since Amerigroup caters to a Medicaid … Read more

Officials at Molina Healthcare closed its online portal for claims information last Friday, fearing a breach of cybersecurity that may have exposed the medical information of some of its 4.8 million members, Kaiser Health News Reports. The company operates in 12 states and Puerto Rico. The company said in a statement: “We are in the … Read more

“Many of us had hoped that medicine would be better than other fields,” says Reshma Jagsi, director of the University of Michigan’s Center for Bioethics and Social Sciences in Medicine. She thought doctors wouldn’t behave “like this.” Time magazine called them the Silence Breakers. Five women, including Ashley Judd and Taylor Swift, featured on the magazine’s … Read more

The clock is counting not just to some Brand New Year, but in addition to some New age in healthcare, the one which is going to be healthier for physicians and patients. This 1 takes hospitals to place their cash and confidential negotiated costs on the web in a easy-to-access arrangement. Soon consumers should have … Read more

Many health care organizations that had reached for the brass ring are now wringing their hands as they file for Chapter 11. All is not lost, however. By Keith J. Shapiro and Nancy A. Peterman Sidebar: Plans with problems Managed care transformed not only the way that our health care system works, but also the … Read more

Needed: A New ‘Bill of Rights’ For Mental Health Care Providers Behavioral health care organizations, argues this administrator, are being monitored to death. He suggests that a set of ground rules be applied to avoid duplication and ensure fairness to all parties Whatever Happened to Exclusive Contracting? A few years ago, experts predicted that HMOs … Read more

PPOs participating in Medicare Advantage can satisfy federal oversight requirements if they’ve already received accreditation from the National Committee for Quality Assurance, according to a ruling by the Centers for Medicare and Medicaid Services. The Medicare reform law passed last year will make regional PPOs available to beneficiaries in 2006. NCQA accreditation is already being … Read more

CT lung screening is an incredible method to discover cellular breakdown in the lungs at the earliest stage yet remains underutilized, in spite of the US Preventive Administrations Team rules gave in 2013, and the American Malignancy Society suggestion that CTLS be furnished to high-hazard patients with admittance to a high-volume, great cellular breakdown in … Read more

Are there lessons to be learned from the HMO that’s doing arguably the nation’s best job of satisfying members? Yes, and one of them is that member satisfaction alone doesn’t assure success. Patrick Mullen Senior Contributing Editor Capital District Physicians’ Health Plan, Albany, N.Y. When physicians in Albany, N.Y., created Capital District Physicians’ Health Plan … Read more

Name Last modified Size Description Parent Directory 28-Aug-2000 11:10 – ../../../../archiveMC/9711/9711.addyears_large.gif 17-May-2000 12:17 17k ../../../../archiveMC/9711/9711.addyears_small.gif 17-May-2000 12:17 11k 9711.amap.shtml 17-May-2000 12:17 8k 9711.capitation_part..> 17-May-2000 12:17 19k 9711.capitation_part..> 17-May-2000 12:18 17k 9711.capitation_part..> 17-May-2000 12:18 8k 9711.compass.map.gif 17-May-2000 12:18 15k 9711.compass.nationa..> 17-May-2000 12:18 15k ../../../../archiveMC/9711/9711.compass.pdf 17-May-2000 12:19 155k 9711.compass.regions..> 17-May-2000 12:19 28k 9711.compass.reportc..> 17-May-2000 12:19 30k 9711.compass.shtml … Read more

More than any other classes of drugs, HMG-CoA reductase inhibitors and proton-pump inhibitors are affected by three-tier formularies. Nearly 4 in 5 HMOs that use a three-tier system will put one or more HMG-CoA reductase inhibitors for treatment of hypercholesterolemia on the third copayment tier, while more than 9 in 10 pharmacy benefit managers will … Read more

Rich data streams from electronic health records, when used appropriately, can transform population-based care management Predictive modeling (PM) has grown to be a linchpin of care management. Health plans, integrated delivery systems, and other health care organizations (HCOs) increasingly channel their patients to interventions based in part on what they deduce from predictive models that … Read more

Much more research is needed to determine the full effect of drug benefit designs, says the author, an official at AstraZeneca. Quality must be the foremost concern. Arthur Lazarus, MD, MBA Newer medications are extremely cost-effective treatments for many people with chronic conditions. Unfortunately, many persons are denied access to these medications because of requirements … Read more

Back in 2014, for example, country officials analyzed 10 3 acute care hospitals which was examined by means of an accreditor at recent 60 times. Their country officials observed 4 1 seri ous deficiencies. Of these, 39 had been overlooked by both the organizations. This disparity”raises critical considerations concerning the [accrediting businesses’] capability to suitably … Read more

Almost 70 percent of 406 human resource executives in a national survey believe that larger investments in wellness programs will help curb health care costs. The main targets of those efforts should be obesity, mental health, and a too-sedentary lifestyle, according to the survey by the Society for Human Resource Management. Eighty-four percent of employers … Read more

Ordinarily, this Compensation Monitor department describes changes in the various payments to providers, folks who work at health plans, and others in the health care industry, but this month, we use compensation as it is usually understood in civil court. From 2000 to 2004, the amount that major malpractice insurers have collected in premiums has … Read more

Florida Blue Tells Folks To Step Right In, Feel at Home Retail stores offer “young invincibles” and the working poor the chance to examine low-cost coverage options Officials at Blue Cross & Blue Shield of Florida didn’t plan for this. They couldn’t have. They launched their Florida Blue stores in 2007, well before it was … Read more

Health-insurance Leads independently and Favorably to the Health of adults also into the reception of proper preventative care and services for chronic and severe ailments. These decisions take into consideration the continuing limits of this largely observational research which affirms themas discussed below. This Last chapter considers the wider consequences of That the Committee’s findings, … Read more

Everyone is afraid of being sued. Health plans don’t want to be sued by their physicians. Neither plans nor doctors want to be sued by patients. And so America’s zeal for litigation has emasculated one tool meant to provide accountability in health care: the hated National Practitioner Data Bank. The Office of the Inspector General’s … Read more

A medical device manufacturer, Definity Health’s first client nearly 5 years ago, has moved a fourth of its employees into the new-style plan In January 2001, 1,300 employees of Medtronic, a medical technology company, began using a health plan administered by Definity Health. Medtronic was Definity’s first client — and one of just a small … Read more

Neil Caesar, J.D. What happens if one physician parks for free in a hospital parking lot to attend a committee meeting and another physician parks for free to make rounds, see patients, and earn a significant amount of money? Does the fact that there is a financial benefit for the physician in one situation, but … Read more

Speaking of pharmaceutical costs, an analysis by Express Scripts/ValueRx, the pharmacy benefit management company, points to new products and increased prescription-drug consumption as factors behind soaring pharmacy expenses. According to the report, prescription drug costs rose 16.1 percent in 1997, the biggest boost in five years. That hike is led by newer agents, which accounted … Read more

Consumers Don’t Know What They Don’t Know All the state-of-the-art health care literacy tools go for naught when faced with such ignorance John Carroll The Ethical Way In a Season of Change Advancing technologies and new coverage designs are creating opportunities — and obligations — for health plan medical directors MargaretAnn Cross Flu’s Other Cost … Read more

BY TIMOTHY KELLEY This month, those quadrennial effusions of hokum and hoopla, the national party political conventions, are upon us again. Nowadays their proceedings are carefully staged for TV, and same-party politicians who castigated each other in February will exchange the equivalent of on-camera valentines. Still, the remarks from the rostrum bear listening to–when the … Read more

PSA Fails the Test, but Does It Matter? Clinical executives at health plans want to see how providers react to draft recommendation against procedure Frank Diamond Insurers Move Toward More Equitable Care For LGBT Population Discrimination persists in many areas, but slow progress is being made Joseph Burns COVER STORY Will ‘Essential Benefits’ Break the … Read more

Women bear the brunt of the system’s dysfunction, and their trust will be hard to earn back. It’s long been recognized that women interact with the health care system more than men—as patients, as caregivers, as coordinators of care for their loved ones, as the managers of medical bills. Given their regular exposure to a … Read more

The managed care network shares new ideas about increasing patient satisfaction, reducing hospital admissions, and producing better outcomes overall Few health plans have the benefit of tracking their members for decades, let alone an entire lifespan. US Family Health Plan (USFHP), one of three managed care plan options under TRICARE, the system that provides civilian … Read more

Under health reform, consumers will be the new buyers in public and private exchanges, meaning care management programs will need a sharper focus on return on investment Success in any retail business comes from offering buyers what they want. Given that insurers will be selling to new retail buyers in the coming years through public … Read more

Also available in PDF Summary The notion of quality of care in medicine is not new, but it is becoming increasingly important as the competitive health care market demands objective measures to compare physicians, hospitals, and managed care organizations. Informatics researchers and health care vendors have responded with computer systems that promise to improve health … Read more